Anticoagulant therapy is either therapeutic or prophylactic. The FDA approves new oral anticoagulants for a variety of clinical applications (see Table 2). The earliest drug approvals focused on reducing the risk of strokes and the prevention of deep vein thrombosis (DVT), which may have led to pulmonary embolism (PE) in patients.
DVT is a common disorder in which a blood clot forms inside a blood vessel and obstructs the flow of blood, which results in the blockage of a vein. DVTs are associated with the use of oral contraceptives, immobilization, pregnancy, trauma, surgery, malignant neoplasms, and older age. DVTs have also been linked to genetic risk factors, most frequently factor V (Leiden) and factor II G20210A mutations. Although the incidence of DVT is 1 or 2 patients/1000 patients each year, the incidence of thrombotic events increases with age and rises to about one patient/100 patients older than 75.
Table 2. Novel Oral Anticoagulants and their Clinical Applications.| Novel Oral Anticoagulant | FDA Approval | Clinical Application |
| Rivaroxaban (Xarelto) | 2011 | Prevent deep vein thrombosis (DVT) in patients undergoing knee and hip replacement. |
| 2011 | Treat and reduce the recurrence of blood clots. |
| 2012 | Prevent stroke in patients with a common type of abnormal heart rhythm. |
| 2018 | Reduce the risk of major cardiovascular events in patients with chronic coronary artery disease or peripheral artery disease. |
| 2019 | Prevent blood clots in acutely ill medical patients. |
| 2021 | Prevent and treat blood clots in pediatric patients. |
| Apixaban (Eliquis) | 2014 | - Reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF).
- Prevent DVT, which may lead to pulmonary embolism (PE) in patients who have undergone hip or knee replacement surgery.
- Treatment of patients with DVT and PE.
- Reduce the risk of recurrent DVTs and PEs following initial therapy.
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| Edoxaban (Lixiana, Savaysa) | 2015 | - Prevent stroke
- Prevention of stroke and non-central-nervous system systemic embolism in patients with nonvalvular AF.
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