Abstract
In this paper we describe the properties and clinical use of new anticoagulants:dabigatran (a direct thrombin inhibitor) and direct anti-Xa agents (rivaroxaban, apixaban,edoxaban ). Major studies that have been performed with these agents in comparisonwith warfarin are reported. Recommendations for use in clinical practice are provided.Information on the disappearance of the anticoagulant effect after stopping drug intakeand on the administration of agents that neutralize the effect of the new anticoagulantis provided. Keywords : warfarin, dabigatran, anti-Xa agents, idarucizumab Address Correspondence to author: Frans Van, MD, PhD, FESC, FACC, FAHA Department of Cardiovascular Sciences University Hospital Leuven Herestraat-49, B-3000 Leuven, Belgium email: frans.vandewerf@uzleuven.be Received: November 10, 2018 Revision received: December 28, 2018 Accepted after revision: January 10, 2018 BKK Med J 2018;14(2): 81-94. DOI: 10.31524/bkkmedj.2018.09.015
Highlights
In this paper we describe the properties and clinical use of new anticoagulants: dabigatran and direct anti-Xa agents
Anticoagulants, drugs that interfere with the coagulation system, are the cornerstone of the prevention and treatment of various clinical manifestations of thrombosis, such as venous thromboembolism (VTE), atrial fibrillation (AF), and thrombosis on mechanical prosthetic heart valves
A novel class of direct acting oral anticoagulants has been developed. These non-vitamin K oral anticoagulants (NOACs) or direct-acting oral anticoagulants (DOACs) feature more predictable pharmacodynamic and pharmacokinetic properties compared to vitamin K antagonists (VKA).[6]
Summary
In this paper we describe the properties and clinical use of new anticoagulants: dabigatran (a direct thrombin inhibitor) and direct anti-Xa agents (rivaroxaban, apixaban, edoxaban ). Anticoagulants, drugs that interfere with the coagulation system, are the cornerstone of the prevention and treatment of various clinical manifestations of thrombosis, such as venous thromboembolism (VTE), atrial fibrillation (AF), and thrombosis on mechanical prosthetic heart valves. To overcome these challenges, a novel class of direct acting oral anticoagulants has been developed. Dr Karl Link was able to isolate the anticoagulant dicoumarol in moldy clover used as cattle food.[1] Warfarin, the first commercially available coumarin derivative, was first marketed as a rodenticide It was not until the 1950s that warfarin started to be used in patients, gaining fame after being prescribed to US president Eisenhower after his heart attack in 1955. As the only available class of oral anticoagulants, vitamin K antagonists (VKA) became the standard for long-term anticoagulant therapy and have been used by many millions of patients
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