Advantages and limitations of the new anticoagulants
Article first published online: 11 OCT 2013
© 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 275, Issue 1, pages 1–11, January 2014
How to Cite
Abstract. (Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada; and Karolinska Institutet, Stockholm, Sweden). Advantages and limitations of the new anticoagulants. (Review). J Intern Med 2014; 275: 1–11.
- Issue published online: 12 DEC 2013
- Article first published online: 11 OCT 2013
- Accepted manuscript online: 30 SEP 2013 09:18AM EST
- factor Xa inhibitor;
- thrombin inhibitor
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 in intracranial bleeding by one-half compared with 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.