New Oral Anticoagulants (NOACs)

How to Subscribe
MLS & MLT Comprehensive CE Package
Includes 175 CE courses, most popular
$109Add to cart
Pick Your Courses
Up to 8 CE hours
$55Add to cart
Individual course$25Add to cart
Need multiple seats for your university or lab? Get a quote
The page below is a sample from the LabCE course New Oral Anticoagulants. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about New Oral Anticoagulants (online CE course)
New Oral Anticoagulants (NOACs)

New oral anticoagulants (NOACs) have revolutionized anticoagulant therapy in recent years. Although the NOACs have limitations in terms of patients who can benefit from them, they have been shown to be effective for treating various conditions.
NOACs have altered the previously accepted therapeutic choices for anticoagulation. NOACs are intended to replace warfarin treatment. The benefits of these drugs include the fact that laboratory testing to monitor therapy is not required. Additional benefits include reduced food and drug interactions and rapid onset of action. However, these drugs are not without their laboratory testing challenges and clinical limitation (Table 1).
The NOACs are a novel class of oral anticoagulants that directly target activated coagulation factors, unlike vitamin K antagonists (VKA). These drugs act directly on specific activated factors. The NOACS have been found to be effective and safe compared with VKA for treating or preventing blood clots in coagulation disorders.
In 2009, the first oral thrombin (factor IIa) inhibitor was approved by the United States Food and Drug Administration (FDA). Two years later, the first of the oral direct factor Xa inhibitors was approved by the FDA.
The terms new oral anticoagulants (NOACs), direct oral anticoagulants, or target-specific oral anticoagulants refer to those oral anticoagulants which specifically inhibit factors IIa (thrombin) or factor Xa. The two broad classes of NOACs are:
  • Direct thrombin factor IIa inhibitors
    • e.g., dabigatran (Pradaxa)
  • Direct factor Xa inhibitors
    • e.g., apixaban (Eliquis), edoxaban (Lixiana, Savaysa), rivaroxaban (Xarelto)
Table 1. New Oral Anticoagulants.
New Oral AnticoagulantMechanism of ActionRenal EliminationApproximate Time to PeakApproximate Time to Trough
Dabigatran Thrombin inhibitor Kidney (80%)1-2 hrs12 hrs
Apixaban Factor Xa inhibitor Kidney (27%)3-4 hrs12 hrs
Edoxaban Factor Xa inhibitor Kidney (50%)1-2 hrs24 hrs
Rivaroxaban Factor Xa inhibitor Kidney (66%)2-4 hrs24 hrs
Adapted from: Akpan IJ, Cuker A.: Lab Assessment of DOACs, Kardiol Pol, 79 (6): 622–630; 2021.