Anticoagulation is a key component in the management of many critically ill patients. Common indications for anticoagulation in critical care include deep venous thrombosis (DVT) and pulmonary embolism (PE) treatment, thromboembolism prophylaxis following orthopedic surgery, stroke prevention in atrial fibrillation, and hypercoagulable conditions. Warfarin has been the mainstay in oral anticoagulation therapy since its first medicinal use in the 1950s.1  The most significant drawback of warfarin therapy is the need for careful monitoring of anticoagulant effects and individualized dosage titration. In recent years, several new oral anticoagulants have been approved and marketed in the United States; these agents include the direct thrombin inhibitor dabigatran and the factor Xa inhibitors rivaroxaban and apixaban. The major benefit of these new agents compared with warfarin is that close monitoring of anticoagulation intensity and individualized dose titration are not necessary. However, these benefits are countered by the lack of a specific reversal agent...

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