Table 1.
| Dabigatran | Rivaroxaban | Apixaban | Edoxaban | Betrixaban | |
|---|---|---|---|---|---|
| Mechanism of action | Direct thrombin inhibitor | Factor Xa inhibitor | Factor Xa inhibitor | Factor Xa inhibitor | Factor Xa inhibitor |
| Time to peak serum level | 1 hour, 2 hours with food | 2–4 hours | 3-4 hours | 1-2 hours | 3-4 hours |
| Elimination half-life (hours) | 12–17 (young), 14–17 h (in elderly) | 5–9 (young), 11–13 (in elderly) | 12 (8–15) | 10–14 | 19–27 |
| Elimination | 80% renal | 70% liver, 30% renal | 30% renal | 50% renal | 11% renal, 89% fecal |
| Bioavailability | 3%–7% | 66%–100% higher with food | 50% | 62% | 34% |
| Dose/frequency NVAF | 150 mg bid (110 mg bid, if age > 80 years) | 20 mg once daily | 5 mg bid | 60 mg once daily | Not licensed |
| VTE therapy and prophylaxis | 150 mg bid (after 5 d of LMWH) | 15 mg bid × 21 d, then 20 mg once daily | 10 mg bid × 7 d, then 5 mg bid | 60 mg bid (after 5 d of LMWH) | 160 mg on day 1, then 80 mg daily |
| VTE prophylaxis post elective hip/knee surgery | 150 mg once daily | 10 mg once daily | 2.5 mg bid | Not licensed | Not licensed |
| P-gp resecretion | Yes | Yes | Yes | Yes | Yes |
| CYP3A4 metabolism | No | Yes | Yes | Minimal | No |
| Follow-up monitoring | Renal function, CBC periodically, at least annually | Renal function, CBC periodically, at least annually; hepatic function | Renal function, CBC periodically, at least annually | Renal function, CBC periodically, at least annually | Renal function, CBC periodically, at least annually |
| Quantitative assay | Dilute thrombin time (dTT), ecarin clotting time (ECT) | Specific, calibrated anti-FXa assays | Specific, calibrated anti-FXa assays | Specific, calibrated anti-FXa assays | Specific, calibrated anti-FXa assays |
Anti-FXa assay = anti-factor Xa assay, bid = twice daily, CBC = complete blood count, CYP3A4 = cytochrome P450 3A4, d = day, DOACs = direct oral anticoagulants, FXa = factor Xa, INR = international normalized ratio, LMWH = low-molecular weight heparin, mg = milligram, NVAF = nonvalvular atrial fibrillation, P-gp = P-glycoprotein, PTT = partial thromboplastin time, and VTE = venous thromboembolism.