Exploring the New Anticoagulants- Pharmacist
Anticoagulants are primarily used to prevent or treat thromboembolic events in patients with conditions including deep-vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation (AF), acute coronary syndrome (ACS), heart or aortic valve replacement, and other hypercoagulable clotting disorders. This issue includes a brief review of the anticoagulants developed over the last 50 years including heparin, warfarin, low molecular weight heparins (enoxaparin [Lovenox®], dalteparin [Fragmin®], tinzaparin [Innohep®]), fondaparinux (Arixtra®), and the direct thrombin inhibitors (DTI) lepirudin (Refludin®), argatroban® and bivalirudin (Angiomax®). The 2 most recently approved anticoagulants, desirudin (Iprivask®) and dabigatran (Pradaxa®), are discussed in detail with special emphasis on dabigatran – the first oral anticoagulant to reach the U.S. market in 50 years. Special concerns with dabigatran and the role of healthcare providers in educating and monitoring patients treated with the new drug are summarized. Dabigatran will likely be joined by other new oral anticoagulants within a few years. An introduction to the two most promising agents, rivaroxaban and apixaban, is also provided. In the Figure and Tables, you’ll find a quick comparison of the key features of both established and new anticoagulants.