What are the names of oral anticoagulant medications?

Oral Anticoagulant Nomenclature

Oral anticoagulants are classified into two main categories: vitamin K antagonists (VKAs) such as warfarin, and direct oral anticoagulants (DOACs) including dabigatran, rivaroxaban, apixaban, edoxaban, and betrixaban. 1

Vitamin K Antagonists (VKAs)

• Warfarin is the prototypical VKA that reduces synthesis of functional vitamin K-dependent clotting factors (II, VII, IX, X) and proteins C and S by interfering with the vitamin K redox cycle. 1

Direct Oral Anticoagulants (DOACs)

The International Society on Thrombosis and Haemostasis (ISTH) formally recommends using the term "direct oral anticoagulants" (DOACs) to describe this class of medications. 1

Specific DOAC Agents:

• Direct thrombin (Factor IIa) inhibitor:

  • Dabigatran 1

• Direct Factor Xa inhibitors:

  • Rivaroxaban 1
  • Apixaban 1
  • Edoxaban 1
  • Betrixaban 1

Key Distinguishing Features of DOACs:

• DOACs directly inhibit a single activated clotting factor (either FIIa or FXa), unlike VKAs which affect multiple factors indirectly. 1
• They have more predictable pharmacokinetic and pharmacodynamic properties than VKAs, eliminating the need for routine anticoagulation monitoring. 1, 2

Important Nomenclature Considerations

Avoid Problematic Terminology:

• The term "NOAC" (novel oral anticoagulant) should be avoided because it has been misinterpreted in medical records as "No AntiCoagulation," potentially resulting in patients not receiving critical anticoagulation therapy. 1
• Alternative terms like "non-VKA oral anticoagulants" or "target-specific oral anticoagulants (TSOACs)" are less preferred. 1

Updated 2023 ISTH Recommendations:

• For emerging anticoagulants targeting factors XI/XIa or XII/XIIa, describe medications by route of administration and specific target (e.g., "oral factor XIa inhibitor"). 1
• This approach provides clarity as newer agents may have distinct risk-benefit profiles, different routes of administration, and unique clinical indications. 1

When Mechanism Matters:

• Use specific mechanism terminology (direct thrombin inhibitor vs. direct Factor Xa inhibitor) when clinically relevant, such as when selecting appropriate coagulation laboratory testing or reversal strategies. 1