The new direct oral anticoagulants in special indications: rationale and preliminary data in cancer, mechanical heart valves, anti-phospholipid syndrome, and heparin-induced thrombocytopenia and beyond.

[heparin-induced thrombocytopenia]

The present review will briefly summarize the interplay between coagulation and inflammation , highlighting possible effects of direct inhibition of factor Xa and thrombin beyond anticoagulation . Additionally , the rationale for the use of the new direct oral anticoagulants (DOACs ) for indications such as cancer -associated venous thromboembolism (CAT ), mechanical heart valves , thrombotic anti-phospholipid syndrome (APS ), and heparin-induced thrombocytopenia (HIT ) will be explored . Published data on patients with cancer or mechanical heart valves treated with DOAC will be discussed , as well as planned studies in APS and HIT . Although at the present time published evidence is insufficient for recommending DOAC in the above-mentioned indications , there are good arguments in favor of clinical trials investigating their efficacy in these contexts . Direct inhibition of factor Xa or thrombin may reveal interesting effects beyond anticoagulation as well .