Direct inhibitors of coagulation proteins - the end of the heparin and low-molecular-weight heparin era for anticoagulant therapy?

摘要

Anticoagulant therapy is used in many medical specialities, with indications including primary and secondary prevention, as well as treatment of both venous and arterial thromboembo-lic events. Heparins, either unfractionated (UFH) or low-molecular-weight (LMWH) heparins, and vitamin K antagonists (VKA) are currently the anticoagulants of choice for the prevention of post-operative venous thromboembolism (VTE) and for the treatment of acute venous and arterial thromboembolism. Although efficacious, these agents are associated with a number of serious drawbacks, such as heparin-induced thrombocytopenia, the need of frequent coagulation monitoring and individual tailoring of therapy, in cases of heparins parenteral mode of administration, reduced patient compliance leading at last to an increased risk of bleeding on the one hand and the risk of thromboembolic complications on the other hand.