Opinion statement
Anticoagulation therapy remains the cornerstone for prevention and treatment of venous thromboembolism. Currently available parenteral anticoagulants, such as heparin, low molecular weight heparin, and fondaparinux, are used widely for short-term therapy, but the need for parenteral administration limits their utility for long-term use. Vitamin K antagonists, such as warfarin, are the only oral anticoagulants available for long-term use. Although effective, these drugs produce a variable anticoagulant response and require routine coagulation monitoring and frequent dose adjustments. New anticoagulants that can be given in fixed doses without monitoring have been developed to overcome the limitations of existing agents. These drugs are in advanced stages of development and have the potential to streamline the prevention and treatment of venous thromboembolism.
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References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Spencer FA, Emery C, Joffe SW, et al.: Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis 2009, 28:401–409.
Heit JA, Silverstein MD, Mohr DN, et al.: Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med 1999, 159:445–453.
Miniati M, Monti S, Bottai M, et al.: Survival and restoration of pulmonary perfusion in a long-term follow-up of patients after acute pulmonary embolism. Medicine (Baltimore) 2006, 85:253–262.
Geerts WH, Bergqvist D, Pineo G, et al.: Prevention of venous thromboembolism: ACCP Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008, 133:381S–453S.
Kearon C, Ginsberg JS, Julian JA, et al.: Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. JAMA 2006, 296:935–942.
Bullano MF, Willey V, Hauch O, et al.: Longitudinal evaluation of health plan cost per venous thromboembolism or bleed event in patients with a prior venous thromboembolism event during hospitalization. J Manag Care Pharm 2005, 11:663–673.
Stangier J, Stahle H, Rathgen K, Fuhr R: Pharmacokinetics and pharmacodynamics of the direct oral thrombin inhibitor dabigatran in healthy elderly subjects. Clin Pharmacokinet 2008, 47:47–59.
Stangier J, Rathgen K, Stahle H, et al.: The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 2007, 64:292–303.
Hauel NH, Nar H, Priepke H, et al.: Structure-based design of novel potent nonpeptide thrombin inhibitors. J Med Chem 2002, 45:1757–1766.
Liesenfeld KH, Schafer HG, Troconiz IF, et al.: Effects of the direct thrombin inhibitor dabigatran on ex vivo coagulation time in orthopaedic surgery patients: a population model analysis. Br J Clin Pharmacol 2006, 62:527–537.
Harenberg J: Development of idraparinux and idrabiotaparinux for anticoagulant therapy. Thromb Haemost 2009, 102:811–815.
Walenga JM, Jeske WP, Fareed J: Short- and long-acting synthetic pentasaccharides as antithrombotic agents. Expert Opin Investig Drugs 2005, 14:847–858.
Kubitza D, Becka M, Voith B, et al.: Safety, pharmacodynamics, and pharmacokinetics of single doses of BAY 59-7939, an oral, direct factor Xa inhibitor. Clin Pharmacol Ther 2005, 78:412–421.
Weinz C, Schwarz T, Kubitza D, et al.: Metabolism and excretion of rivaroxaban, an oral, direct factor Xa inhibitor, in rats, dogs, and humans. Drug Metab Dispos 2009, 37:1056–1064.
Harder S, Parisius J, Picard-Willems B: Monitoring direct FXa-inhibitors and fondaparinux by Prothrombinase-induced Clotting Time (PiCT): relation to FXa-activity and influence of assay modifications. Thromb Res 2008, 123:396–403.
Pinto DJ, Orwat MJ, Koch S, et al.: Discovery of 1-(4-methoxyphenyl)-7-oxo-6-(4-(2-oxopiperidin-1-yl)phenyl)-4,5,6,7-tetrahydro-1H-pyrazolo[3,4-c]pyridine-3-carboxamide (apixaban, BMS-562247), a highly potent, selective, efficacious, and orally bioavailable inhibitor of blood coagulation factor Xa. J Med Chem 2007, 50:5339–5356.
Jiang X, Crain EJ, Luettgen JM, et al.: Apixaban, an oral direct factor Xa inhibitor, inhibits human clot-bound factor Xa activity in vitro. Thromb Haemost 2009, 101:780–782.
Eriksson BI, Dahl OE, Rosencher N, et al.: Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007, 5:2178–2185.
Ginsberg JS, Davidson BL, Comp PC, et al.: Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplasty 2009, 24:1–9.
Eriksson BI, Dahl OE, Rosencher N, et al.: Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 2007, 370:949–956.
• Wolowacz SE, Roskell NS, Plumb JM, et al.: Efficacy and safety of dabigatran etexilate for the prevention of venous thromboembolism following total hip or knee arthroplasty. A meta-analysis. Thromb Haemost 2009, 101:77–85.
•• Schulman S, Kearon C, Kakkar AK, et al.; RE-COVER Study Group: Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009, 361:2342–2352.
• Buller HR, Cohen AT, Davidson B, et al.: Idraparinux versus standard therapy for venous thromboembolic disease. N Engl J Med 2007, 357:1094–1104.
Buller HR, Cohen AT, Davidson B, et al.: Extended prophylaxis of venous thromboembolism with idraparinux. N Engl J Med 2007, 357:1105–1112.
Buller HR, Destors J, Gallus AS, et al.: Idrabiotaparinux, a biotinylated long-acting anticoagulant, in the treatment of deep vein thrombosis (EQUINOX Study): safety, efficacy, and reversibility by avidin [abstract]. Blood 2008, 112:32.
Eriksson BI, Borris LC, Friedman RJ, et al.: Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008, 358:2765–2775.
Kakkar AK, Brenner B, Dahl OE, et al.: Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008, 372:31–39.
Lassen MR, Ageno W, Borris LC, et al.: Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008, 358:2776–2786.
Turpie AG, Lassen MR, Davidson BL, et al.: Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet 2009, 373:1673–1680.
Turpie AG, Lassen MR, Kakkar AK, et al.: Pooled analysis of four rivaroxaban studies: effects on symptomatic events and bleeding [abstract]. J Thromb Haemost 2009, 5(Suppl 2):OC-WE-004.
Buller HR: Once-daily oral rivaroxaban versus placebo in the long-term prevention of recurrent symptomatic venous thromboembolism. The Einstein-Extension Study [abstract]. Blood 2009, 114:LBA-2.
Lassen MR, Raskob GE, Gallus A, et al.: Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N Engl J Med 2009, 361:594–604.
Lassen MR, Gallus AS, Pineo GF, Raskob GE: The ADVANCE-2 study: a randomized double-blind trial comparing apixaban with enoxaparin for thromboprophylaxis after total knee replacement [abstract]. J Thromb Haemost 2009, 5(Suppl 2):LB-MO-005.
•• Connolly SJ, Ezekowitz MD, Yusuf S, et al.: Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009, 361:1139–1151.
Lee AY, Levine MN, Baker RI, et al.: Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003, 349:146–153.
Acknowledgments
Dr. Linkins is the recipient of a New Investigator Award from the Heart and Stroke Foundation of Canada (HSFC). Dr. Weitz holds the Canada Research Chair (Tier 1) in Thrombosis and the Heart and Stroke Foundation of Ontario/J. Fraser Mustard Chair in Cardiovascular Research.
Disclosure
Dr. Weitz is a consultant to and has received honoraria from Sanofi-Aventis, Bristol-Myers Squibb, Pfizer, Bayer, Boehringer-Ingelheim, and Ortho-McNeil. No other potential conflicts of interest were reported.
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Linkins, LA., Weitz, J.I. New and Emerging Anticoagulant Therapies for Venous Thromboembolism. Curr Treat Options Cardio Med 12, 142–155 (2010). https://doi.org/10.1007/s11936-010-0067-8
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DOI: https://doi.org/10.1007/s11936-010-0067-8