Oral antithrombotic inhibitors: dabigatran etexilate, meeting an unmet need?
Although effective, vitamin K antagonists (VKAs) are challenging to use because of their slow onset and offset of action, narrow therapeutic window, multiple dietary and drug interactions, and unpredictable anticoagulant effect. Accordingly, it is recognized that there is an unmet need for an oral thrombotic inhibitor that does not require monitoring and has a rapid onset of action. There is also an unmet need in the field of thromboprophylaxis against venous thromboembolism (VTE) in high-risk patients. The topic of this Supplement is the evidence for the use of dabigatran in high-risk orthopedic patients, namely patients with hip and knee athroplasty. An oral therapy with an immediate reliable and predictable anticoagulant effect without the need for coagulation monitoring and without any long-term hepatic or safety concerns will be a major advance in the management of patients with various thrombotic disorders.
Hull
Russell
R
Thrombosis Research Unit, Foothills Hospital, Calgary, Alberta, Canada. rdhull@ucalgary.ca
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001777:Blood Coagulation / Q000187:drug effects; D002986:Clinical Trials as Topic; D000069604:Dabigatran; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D018570:Risk Assessment; D013917:Thrombin / Q000037:antagonists & inhibitors*; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D001562:Benzimidazoles; D005343:Fibrinolytic Agents; D011725:Pyridines; D013917:Thrombin; D000069604:Dabigatran