The new oral anticoagulants directly inhibit either thrombin (Dabigatran, 
Pradaxa®,) or activated Factor X (rivaroxaban, Xarelto®, and apixaban, Eliquis®) 
and have been approved for thromboprophylaxis after hip and knee replacement 
surgery and stroke prevention in non-valvular atrial fibrillation. Moreover, 
rivaroxaban has been approved for the treatment of deep venous thrombosis, 
prevention of pulmonary embolism and anticoagulation after acute myocardial 
infarction. The direct FXa-inhibitor edoxaban (Lixiana®) expects approval for 
the prevention of stroke in atrial fibrillation in Germany in 2014. The half 
lives of all direct anticoagulants range between 8 and 17 hours. Dabigatran 
(Pradaxa®) and rivaroxaban (Xarelto®) are mainly excreted by the kidneys, 
apixaban (Eliquis®) by the liver (75%) and edoxaban (Lixiana®) by the kidneys 
(40%) and the faeces in 60%. Prior to surgery a shorter cessation is expected 
compared to the vitamin k antagonists phenprocoumon (Marcumar®, Falithrom®) and 
warfarin (Coumadin®). For acute bleedings caused by the direct thrombin 
inhibitor dabigatran (Pradaxa®) hemodialysis is recommended to eliminate the 
drug from the plasma. Due to the high protein binding the direkt FXa-inhibitors 
rivaroxaban (Xarelto®) and apixaban (Eliquis®) can not be hemodialysed. For 
edoxaban (Lixiana®) no data on elimination by renal replacement therapy are 
available. In case of life-threatening bleeding the replacement of a prothrombin 
complex preparation (PCC) containing the factors II, VII, IX and X and, second 
line, activated factor concentrates as recombinant factor VIIa or activated 
prothrombin complex preparations are recommended.