Advantages and limitations of the new anticoagulants.
J Intern Med. 2013 Sep 30;
Authors: Schulman S
During recent years, three new anticoagulants (dabigatran, rivaroxaban, and apixaban) have been introduced to the market, probably with one more anticoagulant (edoxaban) in the next 2 years. This review is not intended to compare the efficacy and risks of these new agents, but rather to detail the advantages and limitations. The pharmacokinetic characteristics of these drugs have few drug and food interactions, predictable dose-responses, and rapid onset and offset, thus resulting in simplified management of the patient requiring anticoagulant therapy. No routine laboratory monitoring is required. A somewhat unexpected, but exciting observation involving the new anticoagulants, is the uniform reduction of intracranial bleeding by one-half compared to warfarin. The potential limitations of the new anticoagulants include uncertainty regarding assessment of drug levels, safe drug levels for major surgery, management of major bleeding, renal dependence, multiple dose regimens, adherence in the absence of frequent monitoring, and unknown, rare side effects that were not captured in the trials. This review should clarify some of these concerns. This article is protected by copyright. All rights reserved.
PMID: 24112453 [PubMed - as supplied by publisher]