New antithrombotic drugs on the horizon.
Venous and arterial thromboembolism are a major cause for morbidity and mortality. The list of established drugs for the prevention of thrombus formation and embolisation includes heparins, hirudin and derivatives, aspirin, ADP and glycoprotein IIb/IIIa receptor antagonists, as well as vitamin K antagonists. Several limitations exist for these drugs that have stimulated the search for new and better anticoagulants. A series of selective clotting factor Xa inhibitors and direct factor IIa (thrombin) inhibitors are on the horizon, two of which are getting close to broad clinical application. Additional therapeutics that are still under preclinical and clinical investigation include inhibitors of the tissue factor pathway/factor VII complex, clotting factor VIII and XIII inhibitors and modulators of the protein C pathway or of endogenous fibrinolysis, as well as novel antiplatelet drugs. This review is focused on the current status of development of novel antithrombotics and their clinical potential. Even though only a few of a broad array of antithrombotic agents have reached clinical testing, some hold the potential for significant improvement in efficacy and safety of anticoagulant therapy.
Division of Cardiology, University of Heidelberg, Bergheimer Str. 58, D-69115 Heidelberg, Germany. johannes_ruef@med.uni-heidelberg.de
Johannes
J
Ruef
Hugo A
HA
Katus
D005167:Factor VII / Q000037:antagonists & inhibitors; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D017395:Plasminogen Activator Inhibitor 1 / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D013925:Thromboplastin / Q000037:antagonists & inhibitors
D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D006490:Hemostatics; D017395:Plasminogen Activator Inhibitor 1; D010975:Platelet Aggregation Inhibitors; D005167:Factor VII; D013925:Thromboplastin; D013917:Thrombin