Cardiovascular Drugs and Therapy

, Volume 26, Issue 3, pp 265-271

First online:

Novel Oral Anticoagulants After Acute Coronary Syndromes

  • Newton B. WigginsAffiliated withDuke University Medical Center
  • , Christopher B. GrangerAffiliated withDuke Clinical Research InstituteDuke University Medical Center
  • , John H. AlexanderAffiliated withDuke Clinical Research InstituteDuke University Medical CenterDuke Clinical Research Institute, Duke University Medical Center Email author 

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A number of novel oral anticoagulants, including direct thrombin inhibitors and direct factor Xa inhibitors, have been developed. This review discusses these agents and their respective clinical trials in patients with acute coronary syndromes.


This review discusses the results of phase 2 and 3 clinical trials with novel oral anticoagulants.


Phase 2 clinical trials demonstrated that novel oral anticoagulants increase the risk of bleeding in a dose-related fashion, particularly when used in addition to dual antiplatelet therapy. What was less clear is their impact on recurrent ischemic events. In phase 3 trials, rivaroxaban was found to have a benefit on ischemic events and perhaps a greater benefit at the lower dose. The phase 3 trial with apixaban was stopped early due to increased bleeding without a meaningful reduction in ischemic events.


Novel oral anticoagulants represent a promising, potentially beneficial treatment for patients with a recent acute coronary syndrome but come with a risk of bleeding. The benefits and risks of these agents will need to be carefully weighed and may depend on both patient risk and concomitant therapy. Additional research is needed to determine how to best integrate these medications into the care of patients with acute coronary syndromes.

Key words

Anticoagulation Acute coronary syndrome Apixaban Rivaroxaban Dabigatran