The quest for new anticoagulants: From clinical development to clinical practice

Abstract

The Vitamin K antagonists (VKAs) have been the standard treatment of thromboembolic diseases for more than 50 years. They have been proved effective and safe under optimal settings; however, the long-term application of VKAs has been considered problematic and challenging for both patients and physicians due to their narrow therapeutic window, the frequent drug to drug interactions and the need for regular monitoring. Novel anticoagulants that selectively block specific pathways of the coagulation cascade have demonstrated efficacy and safety without the need of intensive monitoring. Several novel anticoagulants are already licensed for the prevention and treatment of thromboembolic disease while others are in advanced stages of clinical development. This review summarizes data derived from recently published clinical trials and discusses the present and the future of oral anticoagulation. © 2010 Blackwell Publishing Ltd.