Although warfarin is still used, non-vitamin K antagonists (NOAC) have become increasingly used as antithrombotic agents in the recent years.Several promising therapies, particularly targeting the warfarin replacement are in development.However, despite their widespread use in clinical practice, there are still some unresolved issues on optimizing their use in particular clinical settings (e.g., patients with malignancy or other comorbidities and frail patients).Compared to VKAs, these target-specific drugs have a fixed dosing with no need for international normalized ratio (INR) monitoring, a wider therapeutic index, rapid onset and short half-lives, and few drug and food interactions.
Two classes of DOACs are currently available: reversible direct thrombin inhibitors (i.e., dabigatran) and the direct inhibitors of Xa factor (i.e., rivaroxaban, apixaban, and edoxaban). The direct oral anticoagulants ( DOACs) are a more manageable alternative than vitamin K antagonists (VKAs) to prevent stroke in patients with nonvalvular atrial fibrillation and to prevent and treat venous thromboembolism. Antithrombotic drugs in routine use include antiplatelet drugs (aspirin, clopidogrel, and glycoprotein IIb/IIIa receptor antagonists) and anticoagulants [unfractionated heparin (UFH) and low molecular weight heparin (LMWH), vitamin K antagonists (VKAs), namely warfarin/Coumadin, and non-vitamin K antagonists or non-VKA oral anticoagulants (NOACs) such as direct activated coagulation factor X (FXa) inhibitors and direct thrombin inhibitors (DTIs). The antithrombotic drugs are categorized into three broad types: platelet aggregation inhibitors (PAIs) or anti-platelet agents, fibrinolytics and anticoagulants. Based on the drug classes, the non-vitamin K antagonists segment registered the largest category of antithrombotic agents contributing over 50% of the total market share. The global antithrombotic or anticoagulants drugs market segmented by drug class, and by geography. The global anticoagulant drugs market research report provides market size (revenue $million 2019 to 2029), market share analysis, growth trends and forecast (CAGR%, 2023 to 2029). Anticoagulant reversal agents in active development include for oral or injectable FXa inhibitors, andexanet alfa (AndexXa, Portola), and Ciraparantag (Perosphere). All anticoagulant drugs pose a risk for bleeding. 
Anticoagulants (antithrombotic) are effective for primary and secondary prevention of venous thromboembolism (VTE), for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation (NVAF) and for the prevention of adverse outcomes after acute management of acute coronary syndrome (ACS).Thrombotic (arterial and venous) events are a major complication of CVD. Cardiovascular diseases (CVDs) are the single largest killer worldwide, accounting for ~7.5 million deaths each year.
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