In this paper, recent advances in new anticoagulants with the potential to be used for prevention or treatment of venous thrombosis are reviewed.
Numerous novel anticoagulants targeting specific stages of the coagulant pathway are in various stages of development. Fondaparinux, an indirect activated factor VII inhibitor, has been shown to be effective for initial treatment and prevention of venous thromboembolism, but still requires parenteral administration. Ximelagatran, an oral direct thrombin inhibitor, has also been shown to effective for treatment and prevention of venous thrombosis. Both agents are associated with bleeding, however, and ximelagatran is associated with hepatic toxicity with long-term use. Direct activated factor X inhibitors, orally available forms of heparin, and other direct thrombin inhibitors remain in early stages of development. Further data on the clinical utility of these agents are likely to emerge in the next few years, and uptake of their use will be affected by the cost considerations.
Numerous alternative anticoagulants are in varying stages of development. Clinical data have yet to show that these agents have a clearly superior risk-benefit ratio compared with currently used antithrombotics. Many drugs remain in initial stages of development. The ideal anticoagulant agent is being sought but has yet to be discovered.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Dr Simon J McRae is a recipient of the W E Noonan Fellowship Award. Dr Jeffrey S Ginsberg is a recipient of a Career Investigator Award from the Heart and Stroke Foundation of Ontario and a Research Chair from the Canadian Institutes of Health Research.
Correspondence to Dr Simon J McRae, MBBS, McMaster University Medical Centre, HSC 3W11, 1200 Main St West, Hamilton, Ontario, Canada L8N 3Z5 Tel: 905 521 2100 ext 73928; fax: 905 521 4997; e-mail: email@example.com