Clinical use of new oral anticoagulant drugs: dabigatran and rivaroxaban
- 12 August 2013
- journal article
- review article
- Published by Wiley in British Journal of Haematology
- Vol. 163 (2), 160-167
- https://doi.org/10.1111/bjh.12502
Abstract
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 (ODIs) offer substantial benefits over oral vitamin K antagonists (VKA). However, for the majority of patients with good anticoagulant control with VKAs the advantages of the ODIs 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 VKAs. As yet, specific antidotes to ODIs 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 Xa respectively. The clinical application of these drugs is the focus of the review.Keywords
This publication has 26 references indexed in Scilit:
- Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: Guidance from the British Committee for Standards in HaematologyBritish Journal of Haematology, 2012
- Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisonsBMJ, 2012
- Rivaroxaban: Quantification by anti-FXa assay and influence on coagulation tests: A study in 9 Swiss laboratoriesThrombosis Research, 2012
- Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary EmbolismThe New England Journal of Medicine, 2012
- Evaluation of Prothrombin Complex Concentrate and Recombinant Activated Factor VII to Reverse Rivaroxaban in a Rabbit ModelAnesthesiology, 2012
- Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex ConcentrateCirculation, 2011
- Potential Inaccuracy of Point-of-Care INR in Dabigatran-Treated PatientsAnnals of Pharmacotherapy, 2011
- Oral Rivaroxaban for Symptomatic Venous ThromboembolismThe New England Journal of Medicine, 2010
- Dabigatran versus Warfarin in Patients with Atrial FibrillationThe New England Journal of Medicine, 2009
- The Metabolism and Disposition of the Oral Direct Thrombin Inhibitor, Dabigatran, in HumansDrug Metabolism and Disposition, 2007