Abstract
New oral anticoagulants significantly differ from warfarin in pharmacokinetic and pharmacodynamic characteristics. They are direct and specific inhibitors, targeted on a specific step in the coagulation cascade.
They are used in fixed doses, with no need for laboratory monitoring. They have been evaluated in large controlled clinical trials in the treatment of an acute thromboembolic event as well as in long-term secondary prophylaxis.
Their efficacy is comparable to classical therapy (low-molecular-weight heparin with subsequent warfarin) while the risk of bleeding complications is lower. New oral anticoagulants include rivaroxaban and apixaban (inhibitors of activated factor X) and dabigatran (thrombin inhibitor).
They differ in pharmacokinetics (renal excretion prevails in dabigatran while in apixaban is the lowest) and in recommended dosing (dabigatran and apixaban twice daily, rivaroxaban once daily). The treatment of acute thromboembolic event with rivaroxaban or apixaban may be started from the very beginning while dabigatran must follow initial, at least five days lasting parenteral anticoagulation.
Rivaroxaban has been approved and is covered by health insurance in the therapy of deep vein thrombosis while the approval for dabigatran and apixaban is probably coming soon.