In recent years, several direct-acting oral anticoagulants (DOAC) have become 
available for use in Europe and other regions in indications related to 
prophylaxis and treatment of venous and arterial thromboembolism. They include 
the oral direct thrombin inhibitor dabigatran etexilate (Pradaxa, Boehringer 
Ingelheim) and the oral direct FXa inhibitors rivaroxaban (Xarelto, Bayer 
HealthCare), apixaban (Eliquis, Bristol-Myers Squibb), and edoxaban 
(Lixiana/Savaysa, Daiichi-Sankyo). The new compounds have a predictable dose 
response and few drug-drug interactions (unlike vitamin k antagonists), and they 
do not require parenteral administration (unlike heparins). However, they 
accumulate in patients with renal impairment, lack widely available monitoring 
tests for measuring its anticoagulant activity, and no specific antidotes for 
neutralization in case of overdose and/or severe bleeding are currently 
available. In this review, we describe the pharmacology of the DOAC, the 
efficacy, and safety data from pivotal studies that support their currently 
approved indications and discuss the postmarketing experience available. We also 
summarize practical recommendations to ensure an appropriate use of the DOAC 
according to existing data. Finally, we discuss relevant ongoing studies and 
future perspectives.