Vitamin-K antagonists have played a dominant role in the long-term management of 
patients with venous thromboembolism, and large trials from the past decade 
reinforced warfarin's effectiveness as an intermediate-duration and 
extended-duration anticoagulant. However, promising new oral direct thrombin 
inhibitors are proving to be at least as effective and as safe as the vitamin-K 
antagonists, without the associated hepatic toxicity that was seen with earlier 
orally administered direct thrombin inhibitors. This article reviews the 
recently published Dabigatran versus Warfarin in the Treatment of Acute Venous 
Thromboembolism clinical trial, and discusses the limitations and clinical 
applicability of the trial, especially in comparison with vitamin-K antagonists 
and the recently studied oral direct factor Xa inhibitors, rivaroxaban and 
apixaban.