New antithrombotics in the treatment of thromboembolic disease.
New insights into the in vivo function of the coagulation system have resulted in the development of new antithrombotic agents with a more specific point of impact and more reliable pharmacological properties. Inhibition of coagulation can be achieved by specific thrombin inhibitors (e.g. melagatran), agents specifically targeted at factor Xa (e.g. pentasaccharides), and by tissue factor/factor VIIa blockers (e.g. recombinant NAPc2). In some situations, these agents are more effective and safer than the antithrombotics currently used. However, the major difference may be that the newer generation of antithrombotics does not require repeated laboratory control and dose adjustment to obtain a stable level of anticoagulation; therefore, they are more suitable for application in clinical practice. In this overview, we will briefly discuss the various new compounds that have recently become available or that will be introduced into clinical medicine in the near future and their relative efficacy and safety in comparison to currently used antithrombotic agents.
Levi
Marcel
M
Department of Internal Medicine, Academic Medical Center F-4, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. m.m.levi@amc.uva.nl