35 - Drugs that affect blood coagulation, fibrinolysis, and hemostasis

Abstract

Abstract This review of the 2010 publications on drugs that affect blood coagulation, fibrinolysis, and hemostasis covers coumarin anticoagulants, heparins, danaparoid sodium, direct thrombin inhibitors (argatroban and dabigatran), direct factor Xa inhibitors (apixaban, edoxaban, and rivaroxaban), the indirect factor Xa inhibitor fondaparinux, alteplase, dipyridamole, eptafibatide, clopidogrel, prasugrel, ticagrelor, ticlopidine, tranexamic acid, and protamine. An increasing proportion of the population are receiving long-term antithrombotic therapy for a range of clinical indications, and the choice of agents is broadening with the arrival of a number of new oral anticoagulants and antiplatelet agents. Warfarin is still widely prescribed, and the clinical significance of its interactions with common antibiotics, antidepressants, and lipid-lowering agents has recently been clarified. Dabigatran, a direct thrombin inhibitor, is the first of the new anticoagulants to be widely available and it has been studied in large randomized trials. Dabigatran has a number of drug interactions and its predominant renal clearance should be taken into account when selecting patients to whom it is to be given. The direct factor Xa inhibitor rivaroxaban also appears promising as an alternative anticoagulant to warfarin. Recent studies have also helped to highlight rare adverse reactions to antiplatelet drugs, and the clinical significance of interactions between clopidogrel and both proton pump inhibitors and lipid-lowering agents. The oral thienopyridine ticagrelor appears to be more efficacious than clopidogrel in preventing new thrombotic events in patients with acute coronary syndromes, but the benefit is counterbalanced by an increased risk of bleeding.