Review article The new oral anticoagulants

Although their first application in clinical practice occurred in the 1940s, vitamin K antagonists remain the only form of oral anticoagulant medication approved for long-term use. Although the available vitamin K antagonists are highly effective for the pre-vention and/or treatment of most throm-botic disease, the significant interpatient and intrapatient variability in dose-response, the narrow therapeutic index, and the numer-ous drug and dietary interactions associ-ated with these agents have led clinicians, patients, and investigators to search for alternative agents. Three new orally adminis-tered anticoagulants (apixaban, dabigatran, and rivaroxaban) are in the late stages of development and several others are just entering (or moving through) earlier phases of investigation. These novel anticoagulant medications are being studied for the pre-vention and treatment of venous thrombo-embolism, the treatment of acute coronary syndromes and the prevention of stroke in patients with atrial fibrillation. This review summarizes published clinical trial data per-tinent to apixaban, dabigatran, and rivaroxa-ban. (Blood. 2010;115:15-20