Premium
Clinical use of new oral anticoagulant drugs: dabigatran and rivaroxaban
Author(s) -
Baglin Trevor
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12502
Subject(s) - dabigatran , rivaroxaban , medicine , intensive care medicine , anticoagulant , direct thrombin inhibitor , drug , discovery and development of direct thrombin inhibitors , prothrombin complex concentrate , warfarin , thrombin , pharmacology , atrial fibrillation , platelet
Summary Orally active small molecules that selectively and specifically inhibit coagulation serine proteases have been developed for clinical use. For some patients these oral direct inhibitors ( ODI s) offer substantial benefits over oral vitamin K antagonists ( VKA ). However, for the majority of patients with good anticoagulant control with VKA s the advantages of the ODI s are primarily convenience and few drug interactions. The drugs are prescribed at fixed dose without the need for monitoring or dose adjustment in the majority of patients and the rapid onset of anticoagulation and short half‐life make initiation and interruption of anticoagulation considerably easier than with VKA s. As yet, specific antidotes to ODI s are not available for clinical use but these are in development as rapid reversal agents. As with all anticoagulants produced so far, there is a correlation between intensity of anticoagulation and bleeding. Consequently, the need to consider the balance of benefit and risk in each individual patient is no less important than with VKA therapy. Dabigatran and rivaroxaban have been chosen for this review as examples of a thrombin inhibitor and an inhibitor of factor X a respectively. The clinical application of these drugs is the focus of the review.