Though their first application in clinical practice occurred in the 1940s, vitamin K antagonists (such as warfarin) were the only form of oral anticoagulant medication approved for long-term use for more than 60 years. Warfarin has remained the “gold standard” for decades with no other therapy matching its efficacy rates without serious side effect issues. Although warfarin is highly effective for the prevention and/or treatment of most thrombotic disease, the significant interpatient and intrapatient variability in dose-response, the narrow therapeutic index, and the numerous drug and dietary interactions associated with warfarin has led clinicians, patients, and investigators to search for alternative agents.
Three new orally administered anticoagulants (dabigatran, rivaroxaban and apixaban) have been approved by the FDA. Several others are just entering (or moving through) earlier phases of investigation. These novel anticoagulant medications are being studied for the prevention and treatment of venous thromboembolism, the treatment of acute coronary syndromes and the prevention of stroke in patients with atrial fibrillation.
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