Review – new antithrombotics in cardiology.

In this article, the authors review new antithrombotic agents, with emphasis on those that have been or are likely to be introduced into clinical practice in cardiology. They also briefly review the limitations and advantages of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) as ‘it is these limitations that provide opportunities for new parenteral anticoagulants’. The following agents are discussed:

• Thrombin inhibitors – hirudin, bivalirudin, argatroban, ximelagatran, dabigatran, odiparcil
• Factor Xa inhibitors – fondaparinux, idraparinux, rivaroxaban, razaxaban, otamixaban
• Factor IXa inhibitors
• Role of new anticoagulants by indication – acute coronary syndrome, prevention of arterial thromboembolism in AF, active ischaemic stroke

The authors note that “improvements of new over established anticoagulants are likely to relate to properties other than their inhibition of a specific activated clotting factor. These properties include freedom from non-haemorrhagic side effects, more favourable pharmacokinetics, a predictable dose response that obviates the need for coagulation monitoring, and more appropriate dose selection for the indication of interest”.

Circulation 2007; 116: 552-60 (link to full text, free at time of posting)