Role of novel oral anticoagulants in the management and prevention of venous thromboembolism

Table 1 Comparative pharmacology of novel oral anticoagulants

	Dabigatran	Rivaroxaban	Apixaban	Edoxaban
Target	IIa (thrombin)	Xa	Xa	Xa
Bioavailability	8%	66% without food	50%	62%
		100% with food
Time to peak level (h)	1.25-3	2-4	1-4	1-2
Half life (h)	12-17	5-9 young	12	9-11
		11-13 elderly
Trough	12-24	16-24	12-24	12-24
Drug interactions	Proton pump inhibitors	Potent CYP3A4 and P- glycoprotein inhibitors	Potent CYP3A4 and P- glycoprotein inhibitors	P- glycoprotein inhibitors
Renal excretion	80%	35%	25%	50%
Coagulation test effect	aPPT > 2 × ULN at trough → increased bleeding	Prolonged PT may indicate excess bleeding risk but local calibration required	PT and aPTT prolonged but no known relation to bleeding risk	PT and aPTT prolonged but no known relation to bleeding risk
	dTT at trough > 200 ng/mL or > 65 s → excess bleeding	Anti-FXa chromogenic assays: quantitative but no data on threshold values for bleeding or thrombosis	Anti-FXa chromogenic assays: quantitative but no data on threshold values for bleeding or thrombosis	Anti-FXa chromogenic assays: quantitative but no data on threshold values for bleeding or thrombosis

dTT: Diluted thrombin test.