April 2014, 22:2
05 December 2014
New Oral Anticoagulants
Chee Yen Lin
The approval of the new target specific oral anticoagulants provides clinicians with alternatives to warfarin. This review focuses on dabigatran, a direct thrombin inhibitor and rivaroxavan, a direct factor Xa inhibitor. These new oral anticoagulants have favourable pharmacological properties that overcome many of the problems associated with warfarin use. Their efficacy and safety have also been shown in large Phase III randomized studies in VTE prevention in major orthopedic surgery, treatment of acute VTE and prevention of stroke and systemic embolism in atrial fibrillation. Although bleeding is an anticipated side effect, this risk can be prevented or minimized by appropriate prescribing. Specifically, the oral new anticoagulants should only be used within licensed indications, clinicians should have basic knowledge of their pharmacological properties, particularly their dependence on renal clearance and restrict eligible patients to those with a similar profile as patients included in the original studies. The management of life-threatening bleeding is presently empirical due to the lack of good quality data and specific reversal antidotes are not currently available. All hospitals should develop clinical practice guidelines and have systems in place to ensure the safe and appropriate use of these new anticoagulants.
Warfarin - Enoxaparin - Dabigatran - Major Bleeding - Rivaroxaban
Chee Yen Lin
National University Hospital, Singapore
Correspondence to Yen Lin CHEE, National University Hospital, Singapore.
Telephone: (+65) 6779 5555
E-mail: Yen Lin CHEE <
Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.