A new approach with anticoagulant development: tailoring anticoagulant therapy with dabigatran etexilate according to patient risk

INTRODUCTION: Although vulnerable patients, including the elderly and those with renal impairment or low body weight, are at greater risk of bleeding and/or venous thromboembolism following total hip or total knee replacement, there have been few clinical studies to determine the optimal dose of anticoagulants for this group. AREAS COVERED: For this paper the authors searched the literature for data on efficacy and bleeding rates with low-molecular-weight heparins and fondaparinux in routine clinical practice; and on the effects of standard or reduced dosing with these anticoagulants or with the oral direct thrombin inhibitor dabigatran etexilate in vulnerable patient groups. EXPERT OPINION: Tailoring anticoagulation therapy according to the risk of individual patients is the best way to optimize the benefit/risk of thrombosis and bleeding, and is recommended on treatment guidelines. Specific recommendations for dose reduction have been made for fondaparinux in renal impairment. The availability of two approved doses of dabigatran etexilate for thromboprophylaxis following orthopedic surgery allows the dose to be tailored to the individual patient's characteristics, based on the age and renal function of the patient, as recommended by the European Medicines Agency, in order to maintain efficacy while decreasing bleeding risk.