title: Preparing for the post-warfarin generation of antithrombotics.
abstract: Several antithrombotic agents in development have the potential to greatly simplify the management of patients with AF or at risk for DVT/PE. Ximelagatran has already completed several phase 3 clinical studies in both of these high-risk, high-cost clinical settings and is poised to become the first practical alternative to warfarin. Although the exact therapeutic roles of ximelagatran and other novel antithrombotics further back in the pipeline remain to be determined, the impact of these nonwarfarin alternatives on the current labor-intensive system of anticoagulation clinics seems certain. Most important, the introduction of safer and equally effective oral anticoagulants that do not require monitoring may increase the percentage of high-risk patients who actually receive preventive therapy. If the institutional energy and resources previously spent on anticoagulation clinics, thrombotic disease management, and quality benchmarking can now be redirected to the delivery of the new generation of easier-to-administer and safer antithrombotic agents, the potential to increase rates of preventive therapy initiation and adherence in managed care populations may be within reach. Given the proven clinical value of anticoagulation, this potential increase in the rate of prophylaxis suggests the possibility that, even in the face of a rapidly aging US population, we are nonetheless entering into a period of reduced morbidity, mortality, and costs from stroke and DVT/PE.
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy*; D001384:Azetidines / Q000494:pharmacology; D001562:Benzimidazoles / Q000494:pharmacology; D001596:Benzylamines; D000077144:Clopidogrel; D005343:Fibrinolytic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D000077425:Fondaparinux; D006801:Humans; D009844:Oligosaccharides / Q000494:pharmacology; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011134:Polysaccharides / Q000494:pharmacology; D011355:Prodrugs / Q000494:pharmacology* / Q000627:therapeutic use; D011725:Pyridines / Q000494:pharmacology; D020521:Stroke / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D001384:Azetidines; C453961:BIBR 953; D001562:Benzimidazoles; D001596:Benzylamines; D005343:Fibrinolytic Agents; D009844:Oligosaccharides; D010975:Platelet Aggregation Inhibitors; D011134:Polysaccharides; D011355:Prodrugs; D011725:Pyridines; C426686:ximelagatran; C479958:idraparinux; D000077144:Clopidogrel; D000077425:Fondaparinux; D013988:Ticlopidine