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Br J Pharmacol. 2012 Jan;165(2):363-72. doi: 10.1111/j.1476-5381.2011.01578.x.

New anticoagulants - promising and failed developments.

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1
Clinical Pharmacology, Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. job.harenberg@medma.uni-heidelberg.de

Abstract

New direct and indirect acting factor Xa (FXa) and thrombin inhibitors are being developed to overcome the downsides of the conventional anticoagulants - unfractionated and low molecular weight heparins and vitamin K antagonists. Ximelagatran and idraparinux failed to demonstrate an acceptable safety profile. Rivaroxaban and dabigatran are approved for the post-operative prevention of thromboembolic complications after elective hip or knee replacement surgery; dabigatran is approved for the prevention of embolism in patients with atrial fibrillation in an increasing number of countries. Several novel indirect antithrombin-dependent anticoagulants as well as antithrombin-independent oral direct FXa and thrombin inhibitors are investigated in multiple indications for the prophylaxis and treatment of venous thromboembolism and the prophylaxis of arterial thrombotic disorders. Quality-adjusted life years costs and incremental cost-effectiveness ratios are relatively high at present, but may decrease after approval of more new anticoagulants for additional indications.

PMID:
21740405
PMCID:
PMC3268190
DOI:
10.1111/j.1476-5381.2011.01578.x
[Indexed for MEDLINE]
Free PMC Article
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