Lege Artis Medicinae

[New era of anticoagulation]

LOSONCZY Hajna

SEPTEMBER 20, 2010

Lege Artis Medicinae - 2010;20(09)

[Two types of anticogulants have been introduced into the clinical practice and used succesfully for more than 60 years: the heparins and the cumarins. Blood coagulation is targeted by the two drugs on many sites, their inhibitory action is not specific. The hirudins as specific trombin inhibitors have been introduced later for specific indications. After the discovery of the exact structure of the clotting factors, the drug development could have been directed against its active center which made possible the development of more specific anticoagulants. Some attributes of an ideal anticoagulants: sufficient efficacy with safe administration, predictable therapeutic effect with fixed dosing, no need for monitoring, oral administration, to have a specific antidote, no food or drug interactions. New anticoagulants are inhibitors of the initiation of blood coagulation. Tissue factor pathway inhibitors; inhibitors of the propagation of clotting process: activated protein C; indirect factor Xa inhibitors (requiering antithrombin to its actions: pentasaccharide, idrabiotaparinux and ultra-low-molecular weight heparins); direct FXa inhibitors, acting without antithrombin: rivaroxaban and apixaban; and out of the direct oral thrombin inhibitors acting against fibrin-formation, dabigatran-etexilate are discussed.]

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