New oral anticoagulants for treatment of venous thromboembolism

In the current treatment of venous thromboembolism most patients are treated with vitamin K antagonists (VKA). VKA have many disadvantages including slow onset of action, multiple food and drug interactions and a large inter-individual variability in their efficacy. Recently several alternative oral anticoagulants have been developed, which have several advantages in comparison to VKA. So far two large randomized studies comparing new oral anticoagulants with VKA in patients with venous thromboembolism have been published: the RECOVER study with the oral direct thrombin antagonist dabigatran and the EINSTEIN-DVT study with the oral direct factor Xa-antagonist rivaroxaban. With regard to recurrent venous thromboembolism and bleeding complications, both drugs were comparable with VKA. In addition, two other studies are ongoing with the oral direct factor Xa antagonists apixaban and edoxaban for this indication. The final role of the new oral anticoagulants in the future treatment of venous thromboembolism has to be determined. However the first results from randomized trails are encouraging. © 2011 Georg Thieme Verlag KG Stuttgart.