The Direct Oral Anticoagulants Apixaban, Rivaroxaban, and Edoxaban

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Figure 1.
Target Specificity of DOACs Compared to VKAs
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Figure 2.
Sites of Interaction between DOAC and factor Xa

Table 1.

Overview of Selected Oral Anticoagulant Agents in the U.S.

Drug	Rivaroxaban	Apixaban	Edoxaban
Mech. of action	Factor Xa inhibitor	Factor Xa inhibitor	Factor Xa inhibitor
Prodrug	No	No	No
Bioavailability	66 – 100% (dose dependent)	50%	62%
Protein Binding	92 – 95%	87%	40 – 50%
Coagulation Monitoring Required	No	No	No
Half-life (hours)	5 - 9	12	5.8 – 10.7
Elimination	Renal and Hepatic	Renal and Hepatic	Renal and Hepatic
Renal Dose Adjustment	Yes	Yes	Yes (based on clinical trials)
Drug Interactions	Substrate of CYP450 3A4/5, 2J2 and P-gp	Substrate of CYP450 3A4/5, and P-gp	Substrate of P-gp
Reversal Agent Approved	No	No	No
Dialyzable	Not expected	Not expected	Data not available
Indications	Reduce stroke and systemic embolism in nonvalvular AF; treatment of DVT or PE or prevention of their recurrence; prophylaxis of DVT in those undergoing hip or knee surgery	Reduce stroke and systemic embolism in nonvalvular AF; treatment of DVT or PE or prevention of their recurrence; prophylaxis of DVT in those undergoing hip or knee surgery	Reduce stroke and systemic embolism in nonvalvular AF; treatment of DVT or PE or prevention of their recurrent, symptomatic VTE

A comparison and summary of selected characteristics of the direct oral anticoagulants Rivaroxaban, Apixaban and Edoxaban
AF = atrial fibrillation, DVT = deep vein thrombosis, PE = pulmonary embolism; P-gp = P=glycoprotein; VTE = venous thromboembolism Adapted from ⁽²⁾ with permission of authors.