Development and Clinical Applications of Novel Oral Anticoagulants. Part I. Clinically Approved Drugs

Two new classes of orally available anticoagulant drugs, the direct thrombin inhibitor (dabigatran etexilate) and direct factor Xa inhibitors (the -xabans), have been approved for various clinical indications, as alternatives to the vitamin K antagonists (e.g., warfarin). These include the prevention of venous thromboembolism after major orthopedic surgery, the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, and the secondary prevention and treatment of venous thromboembolism including pulmonary embolism. Other clinical indications including the add-on therapy to dual antiplatelet therapy in patients with acute coronary syndrome and extended prophylaxis of venous thromboembolism in acute medically ill patients are currently under clinical investigation. The clinical phase III development and indications of the currently clinically approved novel oral anticoagulants dabigatran etexilate, rivaroxaban, apixaban, and edoxaban are summarized and discussed. [Discovery Medicine 13(73):433-443, June 2012]