Garcia D, Libby E, Crowther MA
The new oral anticoagulants. [JOURNAL ARTICLE]
Blood 2009 Oct 30.
Although their first application in clinical practice occurred in the 1940s, vitamin K antagonists (VKAs) remain the only form of oral anticoagulant medication approved for long-term use. While the available VKAs are highly effective for the prevention and/or treatment of most thrombotic disease, the significant inter- and intra-patient variability in dose-response, the narrow therapeutic index, and the numerous drug and dietary interactions associated with these agents have led clinicians, patients, and investigators to search for alternative agents. Three new orally administered anticoagulants (apixaban, dabigatran, and rivaroxaban) are in the late stages of development and several others are just entering (or moving through) earlier phases of investigation. These novel anticoagulant medications are being studied for the prevention and treatment of venous thromboembolism, the treatment of acute coronary syndromes and the prevention of stroke in patients with atrial fibrillation. This review will summarize published clinical trial data pertinent to apixaban, dabigatran and rivaroxaban.
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