From Warfarin to DOACs in modern oral anticoagulant therapy

Oral anticoagulation therapy plays a critical role in the prevention of thromboembolic diseases. For many years, vitamin K antagonists (VKAs) such as warfarin were the standard treatment. However, direct-acting oral anticoagulants (DOACs/NOACs), which have emerged in recent years, have become the treatment of choice. Direct oral anticoagulants (DOACs), also known as non–vitamin K antagonist oral anticoagulants, are a newer class of anticoagulant agents that directly target key components of the coagulation cascade. These agents include oral direct thrombin inhibitors and factor Xa inhibitors. DOACs are currently approved for several clinical indications, including the prevention of stroke in patients with atrial fibrillation, as well as the treatment and secondary prevention of venous thromboembolism. 
Compared with traditional anticoagulants such as warfarin, DOACs offer several practical advantages, including predictable pharmacokinetics, fewer dietary and drug interactions, and no routine coagulation monitoring requirements. Emerging evidence from both preclinical and clinical studies suggests that DOACs exhibit a favorable safety profile, particularly with respect to reduced risk of major bleeding events. Despite these benefits, conventional anticoagulants are still widely used in clinical practice due to long-term experience, cost considerations, and specific patient-related factors.
This review provides a comprehensive overview of the pharmacological characteristics of DOACs, with particular emphasis on their mechanisms of action, clinical efficacy, and safety profiles. Furthermore, current laboratory assessment strategies and available reversal agents are discussed in light of recent advances and evidence from experimental and clinical studies.