The management of coagulation abnormalities plays a central role in many pathological conditions, especally in cardiac and vascular diseases diseases, a major cause of morbidity and mortality globally.
The quest for more effective and advanced therapeutic options has led to the development of direct oral anticoagulants (DOACs), such as Apixaban, Rivaroxaban, Edoxaban and Dabigatran with mechanisms of action distinct from traditional coumarin anticoagulants.
Coumarin anticoagulants, like warfarin, act by inhibiting hepatic synthesis of vitamin K-dependent coagulation factors. However, their use is associated with sev eral limitations, including dose variability and the need for frequent monitoring.
In contrast, DOACs specifically and directly target key coagulation factors.
Apixaban inhibits factor Xa, rivaroxaban also acts by inhibiting factor Xa, while Edoxaban inhibits both factor Xa and factor IIa and Dabigatran is capable of binding and inhibiting both free and clot-bound thrombin. These agents exhibit a predictable action profile, eliminating the need for frequent monitoring, and offer more strimelined management of coagulation abnormalities. From a safety perspective, DOACs demonstrate a reduced risk of major and minor bleeding compared to coumarin anticoagulants. Their selective action on specific coagulation factors plays a fundamental role in maintaining an appropriate balance between coagulation control and bleeding prevention.
The convenience of using DOACs is further emphasized by their fixed dosages, eliminating the need for frequent adjustments. This not only simplifies clinical management but also enhances treatment adherence, contributing to the overall effectiveness and safety of anticoagulant therapy.
In conclusion, direct oral anticoagulants represent a significant breakthrough in the management of thrombophilia and all the assocaited pathologiacl conditions. Their targeted mechanism of action, predictable effect, safety, and ease of use position them as advanced therapeutic options compared to coumarin anticoagulants, opening new perspectives in the treatment of several life-threatening pathological conditions.