Special feature Oral anticoagulants

Oral anticoagulants are used to manage a variety of common age-related conditions (e.g., atrial fibrillation), and the frequency of their use will likely rise significantly in the United States as the population ages. The number of elderly Americans 65 years of age or older is expected to increase markedly over the next two decades, from 39.6 million in 2009 to 72.1 million by 2030. Nearly one in five Americans will be elderly in 2030. Warfarin has been widely used since it was introduced more than 50 years ago, but it is a less-than-ideal anticoagulant because of its narrow therapeutic range, interactions with numerous drugs and foods, and need for routine laboratory monitoring. Warfarin is a common cause of emergency hospitalization in elderly patients and of serious, disabling, or fatal injury from bleeding in patients of all ages. The recent introduction of the oral direct thrombin (factor IIa)