New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events
Top Cited Papers
Open Access
- 1 June 2015
- journal article
- review article
- Published by Informa UK Limited in Therapeutics and Clinical Risk Management
- Vol. ume 11, 967-977
- https://doi.org/10.2147/tcrm.s84210
Abstract
Despite the discovery and application of many parenteral (unfractionated and low-molecular-weight heparins) and oral anticoagulant vitamin K antagonist (VKA) drugs, the prevention and treatment of venous and arterial thrombotic phenomena remain major medical challenges. Furthermore, VKAs are the only oral anticoagulants used during the past 60 years. The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies. NOACs are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). Several NOACs, such as dabigatran (a direct inhibitor of FIIa) and rivaroxaban, apixaban and edoxaban (direct inhibitors of factor Xa), have been used for at least 5 years but possibly 10 years. Unlike traditional VKAs, which prevent the coagulation process by suppressing the synthesis of vitamin K-dependent factors, NOACs directly inhibit key proteases (factors IIa and Xa). The important indications of these drugs are the prevention and treatment of deep vein thrombosis and pulmonary embolisms, and the prevention of atherothrombotic events in the heart and brain of patients with acute coronary syndrome and atrial fibrillation. They are not fixed, and dose-various strengths are available. Most studies have reported that more advantages than disadvantages for NOACs when compared with VKAs, with the most important advantages of NOACs including safety issues (ie, a lower incidence of major bleeding), convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring. Nonetheless, there are some conditions for which VKAs remain the drug of choice. Based on the available data, we can conclude that NOACs have greater advantages and fewer disadvantages compared with VKAs. New studies are required to further assess the efficacy of NOACs.Keywords
This publication has 67 references indexed in Scilit:
- Rivaroxaban for Thromboprophylaxis in Acutely Ill Medical PatientsNew England Journal of Medicine, 2013
- The Influence of Age and Gender on the Pharmacokinetics and Pharmacodynamics of Rivaroxaban—An Oral, Direct Factor Xa InhibitorThe Journal of Clinical Pharmacology, 2013
- Rivaroxaban and other novel oral anticoagulants: pharmacokinetics in healthy subjects, specific patient populations and relevance of coagulation monitoringThrombosis Journal, 2013
- A case report describing a suspected rivaroxaban hypersensitivity reaction in a surgical patientJournal of Clinical Pharmacy & Therapeutics, 2012
- The promise of novel direct oral anticoagulantsBest Practice & Research Clinical Haematology, 2012
- Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary EmbolismNew England Journal of Medicine, 2012
- Myocardial Ischemic Events in Patients With Atrial Fibrillation Treated With Dabigatran or Warfarin in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) TrialCell Metabolism, 2012
- Rivaroxaban in Patients with a Recent Acute Coronary SyndromeNew England Journal of Medicine, 2012
- New AnticoagulantsCirculation, 2010
- The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjectsBritish Journal of Clinical Pharmacology, 2007