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Thromb Haemost 2010; 104(01): 49-60
DOI: 10.1160/TH09-05-0327
Review Article
Schattauer GmbH

New oral anticoagulant drugs in cardiovascular disease

Ingo Ahrens
1   Innere Medizin III, Kardiologie und Angiologie, Universitätsklinik Freiburg, Freiburg, Germany
,
Gregory Y. H. Lip
2   Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham,UK
,
Karlheinz Peter
3   Atherothrombosis & Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
› Author Affiliations
Further Information

Publication History

Received: 24 May 2009

Accepted after major revision: 08 March 2010

Publication Date:
23 November 2017 (online)

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Summary

Oral anticoagulation has been limited to vitamin K antagonists (VKAs) for over 60 years. VKAs are effective and recommended for the prevention of venous and arterial thromboembolism in cardiovascular disease, but their pharmacodynamics are difficult to predict and the highly variable interindividual and intraindividual response to treatment accounts for the need of continuous monitoring. This prompted the intensive exploration of numerous substances within the last decade in an attempt to meet the shortcomings of current oral anticoagulation with VKAs. The development and clinical investigation of two novel groups of oral anticoagulants targeting central factors of the coagulation system either factor Xa or thrombin (factor IIa) has now reached the daily clinical practice with the approval of the oral direct thrombin inhibitor dabigatran etexilate and the oral direct factor Xa inhibitor rivaroxaban. Ongoing clinical trials are investigating these substances and other novel oral anticoagulants with similar mechanisms of action in patients with atrial fibrillation and acute coronary syndromes. This review article discusses the clinical evaluation and pharmacological properties of novel oral anticoagulants in late and earlier stages of clinical development, thereby providing a critical analysis and an outlook on the future of oral anticoagulation in cardiovascular disease.

Keywords

Novel oral anticoagulants - direct thrombin inhibitor - Xa-inhibitor - vit-amin-k-antagonist - cardiovascular disease
 

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