Review articlesNovel anticoagulants in clinical development: focus on factor Xa and direct thrombin inhibitorsSteffel, Jan; Lüscher, Thomas FAuthor Information aCardioVascular Center, University Hospital Zurich, Switzerland bInstitute of Physiology, Cardiovascular Research, University of Zurich-Irchel, Zurich, Switzerland Received 1 June, 2009 Accepted 1 June, 2009 Correspondence to Thomas F. Lüscher, MD, FRCP, FESC, Professor and Chairman of Cardiology, CardioVascular Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland Tel: +41 44 255 2121; fax: +41 44 255 4251; e-mail: [email protected] Journal of Cardiovascular Medicine: August 2009 - Volume 10 - Issue 8 - p 616-623 doi: 10.2459/JCM.0b013e32832edac0 Buy Metrics Abstract Vitamin K antagonists are the mainstay in the prevention and treatment of thromboembolic diseases. Although effective under optimal conditions, several drawbacks are imminent to the long-term application of these drugs due to their narrow therapeutic window, interactions with other drugs as well as the need for regular monitoring and the risk of a recurrent event versus the risk of bleeding. To overcome these downsides, novel anticoagulants are being developed; in contrast to vitamin K antagonists, these novel agents specifically and selectively block central elements of the coagulation cascade. Several clinical trials have demonstrated the efficacy and safety of selective FXa inhibitors (such as fondaparinux, rivaroxaban, apixaban) and direct thrombin inhibitors (such as lepirudin, bivalirudin, dabigatran etexilate) in the treatment of typical indications for conventional vitamin K antagonists, in particular, the prevention and treatment of venous thromboembolism. This review summarizes the results and designs of recently published and ongoing clinical trials of novel anticoagulants. © 2009 Italian Federation of Cardiology. All rights reserved.