American Society of Hirudotherapy

Direct oral anticoagulants: An update.

Review published in Medicina clinica (2017)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical TrialsDrug DevelopmentFranco Moreno et al. · Medicina clinica, 2017

Abstract

Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In randomised controlled trials comparing direct oral anticoagulants with traditional vitamin K antagonists, the direct oral anticoagulants all showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromboembolism and acute coronary syndrome. In 2008, dabigatran was the first direct oral anticoagulant approved by the European Medicine Agency. Subsequently, rivaroxaban, apixaban and edoxaban were also authorised. This article reviews the evidence related to the use of these drugs.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsAcute Coronary SyndromeAdministration, OralAnticoagulantsAntithrombinsAtrial FibrillationClinical Trials as TopicDabigatranFactor Xa InhibitorsHemorrhageHumansPostoperative ComplicationsPyrazoles

Summary

Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban).

Why This Matters for Hirudotherapy

This review provides an update on direct oral anticoagulants (DOACs), specifically comparing the efficacy and safety of direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) against traditional vitamin K antagonists. It highlights their favorable benefit-risk profile in treating thromboembolic events related to atrial fibrillation and venous thromboembolism. The relevance of this article to the ASH domain is entirely indirect, as both thrombin inhibition and factor Xa inhibition are primary mechanisms utilized by the leech secretome to maintain blood fluidity. Understanding the clinical success of these synthetic pathways validates the biological targets naturally evolved by leeches. However, no leeches, hirudin, or leech-derived compounds are mentioned, making this a background piece on general pharmacology rather than a hirudotherapy study.

Citation

Direct oral anticoagulants: An update.

Franco Moreno et al. · Medicina clinica, 2017

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.