Novel oral anticoagulants, including direct thrombin and factor Xa inhibitors, offer alternatives to vitamin K antagonists for thromboembolism prevention in cardiovascular disease.
This review summarizes the pharmacological properties and clinical evaluation of novel oral anticoagulants as alternatives to vitamin K antagonists for the prevention of thromboembolism in cardiovascular disease.
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.
Lip et al. (Fri,) conducted a review in Cardiovascular disease. Novel oral anticoagulants (e.g., dabigatran etexilate, rivaroxaban) vs. Vitamin K antagonists was evaluated. Novel oral anticoagulants, including direct thrombin and factor Xa inhibitors, offer alternatives to vitamin K antagonists for thromboembolism prevention in cardiovascular disease.