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Thromb Haemost 2009; 102(05): 892-899
DOI: 10.1160/TH09-02-0134
Theme Issue Article
Schattauer GmbH

Direct inhibitors of coagulation proteins – the end of the heparin and low-molecular-weight heparin era for anticoagulant therapy?

Volker Laux
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Elisabeth Perzborn
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Stefan Heitmeier
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Georges von Degenfeld
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Elke Dittrich-Wengenroth
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Anja Buchmüller
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Christoph Gerdes
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
,
Frank Misselwitz
1   Acute Care Research, Global Drug Discovery Research, Bayer Schering Pharma, Wuppertal, Germany
› Author Affiliations
Further Information

Publication History

Received: 27 February 2009

Accepted after minor revision: 17 May 2009

Publication Date:
27 November 2017 (online)

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Summary

Heparins, either unfractionated or low-molecular-weight (UFH and LMWHs), and vitamin K antagonists (VKAs) are currently the anticoagulants of choice for the prevention of post-operative venous thromboembolism (VTE) and for the treatment of acute venous and arterial thromboembolism. While VKAs are widely used in the US, LMWHs are the standard of care in the EU. Although efficacious, these agents are associated with a number of drawbacks, such as the risk of heparin-induced thrombocytopenia, the need for frequent coagulation monitoring in the case of UFH and VKAs, and the parenteral mode of administration in the case of heparins, which can lead to problems associated with patient compliance. There is a need for new anticoagulants that overcome these limitations. Direct, small-molecule inhibitors of coagulation proteins targeting a single enzyme in the coagulation cascade – particularly thrombin or Factor Xa – have been developed in recent years. Two agents, the direct thrombin inhibitor dabigatran and the direct Factor Xa inhibitor rivaroxaban, have recently been approved in the EU and several other countries for the prevention of VTE after total hip or knee replacement surgery. Here we will review data that suggest that the antithrombin-independent mechanism of action of these agents, particularly that of direct Factor Xa inhibitors, leads to increased efficacy with similar safety profiles compared with the antithrombin-dependent heparins. Although the end of the heparins era is not to be expected, the new anticoagulants presented in this review potentially represent the future of anticoagulation.

Keywords

Factor Xa - direct thrombin inhibitors - antithrombin-dependent inhibitors - rivaroxaban - heparin
 

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