title: New anticoagulants - promising and failed developments.
abstract: New direct and indirect acting factor Xa (FXa) and thrombin inhibitors are being developed to overcome the downsides of the conventional anticoagulants - unfractionated and low molecular weight heparins and vitamin K antagonists. Ximelagatran and idraparinux failed to demonstrate an acceptable safety profile. Rivaroxaban and dabigatran are approved for the post-operative prevention of thromboembolic complications after elective hip or knee replacement surgery; dabigatran is approved for the prevention of embolism in patients with atrial fibrillation in an increasing number of countries. Several novel indirect antithrombin-dependent anticoagulants as well as antithrombin-independent oral direct FXa and thrombin inhibitors are investigated in multiple indications for the prophylaxis and treatment of venous thromboembolism and the prophylaxis of arterial thrombotic disorders. Quality-adjusted life years costs and incremental cost-effectiveness ratios are relatively high at present, but may decrease after approval of more new anticoagulants for additional indications.
authors: Clinical Pharmacology, Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. job.harenberg@medma.uni-heidelberg.de
authors: Job
authors: J
authors: Harenberg
authors: Svetlana
authors: S
authors: Marx
authors: Martin
authors: M
authors: Krejczy
authors: Martin
authors: M
authors: Wehling
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use*; D065427:Factor Xa Inhibitors; D006801:Humans; D013917:Thrombin / Q000037:antagonists & inhibitors; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D013917:Thrombin