New Oral Anticoagulants

Chee Yen Lin
2014 ASEAN Heart Journal  
The approval of the new target specifi c oral anticoagulants provides clinicians with alternatives to warfarin. This review focuses on dabigatran, a direct thrombin inhibitor and rivaroxavan, a direct factor Xa inhibitor. These new oral anticoagulants have favourable pharmacological properties that overcome many of the problems associated with warfarin use. Their effi cacy and safety have also been shown in large Phase III randomized studies in VTE prevention in major orthopedic surgery,
more » ... dic surgery, treatment of acute VTE and prevention of stroke and systemic embolism in atrial fi brillation. Although bleeding is an anticipated side effect, this risk can be prevented or minimized by appropriate prescribing. Specifi cally, the oral new anticoagulants should only be used within licensed indications, clinicians should have basic knowledge of their pharmacological properties, particularly their dependence on renal clearance and restrict eligible patients to those with a similar profi le as patients included in the original studies. The management of life-threatening bleeding is presently empirical due to the lack of good quality data and specifi c reversal antidotes are not currently available. All hospitals should develop clinical practice guidelines and have systems in place to ensure the safe and appropriate use of these new anticoagulants.
doi:10.7603/s40602-014-0002-4 fatcat:tl5zj3jcujdtphm6tqkuya2aqa