February 22, 2008Arteriosclerosis Thrombosis and Vascular Biology176 citations
View Full PaperNew Anticoagulants for Treatment of Venous Thromboembolism
Key Result
Emerging anticoagulants, including idraparinux and new oral agents targeting thrombin or factor Xa, have the potential to streamline the treatment of venous thromboembolism.
Structured PICO
Do emerging anticoagulants (idraparinux and new oral anticoagulants) improve the treatment and management of venous thromboembolism compared to standard therapy?
P
Population
Patients with venous thromboembolism (VTE)
I
Intervention
Emerging anticoagulants including idraparinux (once-weekly subcutaneous) and new oral anticoagulants targeting thrombin or factor Xa
C
Comparator
Standard anticoagulant therapy (parenteral agents such as heparin, low-molecular-weight heparin, or fondaparinux, and vitamin K antagonists such as warfarin)
This review outlines the pharmacology, clinical trial results, and evolving role of emerging anticoagulants like idraparinux and direct oral anticoagulants for VTE treatment.
Abstract
Anticoagulant therapy is the cornerstone of treatment of venous thromboembolism (VTE). Such treatment is divided into 2 stages: Rapid initial anticoagulation is given to minimize the risk of thrombus extension and fatal pulmonary embolism, whereas extended anticoagulation is aimed at preventing recurrent VTE, thereby reducing the risk of postphlebitic syndrome. With currently available drugs, immediate anticoagulation can only be achieved with parenteral agents, such as heparin, low-molecular-weight heparin, or fondaparinux. Extended treatment usually involves the administration of vitamin K antagonists, such as warfarin. Emerging anticoagulants have the potential to streamline VTE treatment. These agents include idraparinux, a long-acting synthetic pentasaccharide that is given subcutaneously on a once-weekly basis, and new oral anticoagulants that target thrombin or factor Xa. This article (1) reviews the pharmacology of these agents, (2) outlines their potential strengths and weaknesses, (3) describes the results of clinical trials with these new drugs, and (4) identifies the evolving role of new anticoagulants in the management of VTE.