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July 14, 2011British Journal of PharmacologyOpen Access

New anticoagulants – promising and failed developments

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Why the study?

Do new direct and indirect acting factor Xa and thrombin inhibitors provide safe and effective alternatives to conventional anticoagulants for the prevention and treatment of thromboembolic disorders?

Population

Patients requiring anticoagulation for prevention or treatment of thromboembolic disorders

Comparison

New direct and indirect acting factor Xa and… vs Conventional anticoagulants

Design

Review

Authors

JHJob HarenbergHeidelberg UniversitySMSvetlana MarxUniversity of MannheimMKMartin KrejczyBG University Hospital Bergmannsheil Bochum

Discussion

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Overview

Approved agents merit selective use amid high costs; leaves open optimal positioning and long-term safety versus conventional therapy.

Key Points

  • The aim is to evaluate new anticoagulants including their development, effectiveness, and safety compared to traditional options.
  • Reviewed efficacy and safety profiles of novel anticoagulants
  • Discussed approved medications for post-operative prevention of thromboembolic complications
  • Analyzed cost-effectiveness ratios of newer anticoagulants
  • Rivaroxaban and dabigatran are effective for post-operative thromboembolic prevention
  • Ximelagatran and idraparinux showed unacceptable safety profiles
  • Current costs for new anticoagulants are high but may decrease with broader approvals

Structured PICO

Do new direct and indirect acting factor Xa and thrombin inhibitors provide safe and effective alternatives to conventional anticoagulants for the prevention and treatment of thromboembolic disorders?

P
Population
Patients requiring anticoagulation for prevention or treatment of thromboembolic disorders (e.g., post-operative hip/knee replacement, atrial fibrillation)
I
Intervention
New direct and indirect acting factor Xa and thrombin inhibitors (e.g., rivaroxaban, dabigatran, ximelagatran, idraparinux)
C
Comparator
Conventional anticoagulants (unfractionated and low molecular weight heparins, vitamin K antagonists)

Novel anticoagulants like rivaroxaban and dabigatran are emerging as approved alternatives to conventional anticoagulants, despite the safety failures of earlier agents and currently high cost-effectiveness ratios.

Cite This Study

Harenberg et al. (2011) studied this question.

synapsesocial.com/papers/6a212dafa2a97f3a085ac6d7https://doi.org/10.1111/j.1476-5381.2011.01578.x

Topics

Anticoagulation in AF
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Development of New Anticoagulants: Present and Future2008 · 23 citations
  2. 2Novel factor Xa inhibitors for prevention and treatment of thromboembolic diseases2006 · 106 citations
  3. 3Development of idraparinux and idrabiotaparinux for anticoagulant therapy2009 · 47 citations
  4. 4Preclinical discovery of apixaban, a direct and orally bioavailable factor Xa inhibitor2011 · 194 citations
  5. 5Antithrombotic and Anticoagulant Profiles of TAK-442, a Novel Factor Xa Inhibitor, in a Rabbit Model of Venous Thrombosis2010 · 11 citations