New Oral Anticoagulants Poised to Usurp the Throne of Vitamin K Antagonists After Over Half a Century

Only after the elapse of over half-a-century of warfarin's reign are we witnessing significant progress in anticoagulation therapy with the advent of new anticoagulants with predictable pharmacologic profile obviating the need for the routine and burdening coagulation monitoring unlike therapy with vitamin K antagonists. Furthermore, these novel agents are devoid of any food interactions and have limited drug-drug interactions since they are minimally metabolized via the cytochrome P450. These unique pharmacokinetic properties have ushered in a new era in anticoagulation therapy with the continuing development of specific direct factor IIa (thrombin) and factor Xa inhibitors. An overview of these novel anticoagulant agents is herein attempted.