Changing practice of anticoagulation: will target-specific anticoagulants replace warfarin?

Journal Article (Review)

The target-specific oral anticoagulants are a class of agents that inhibit factor Xa or thrombin. They are effective and safe compared to warfarin for the prevention of stroke and systemic embolism in patients with atrial fibrillation and for the treatment of venous thromboembolism, and they are comparable to low-molecular-weight heparin for thromboprophylaxis after hip or knee arthroplasty. For other indications, however, such as the prevention of stroke in patients with mechanical heart valves, initial studies have been unfavorable for the newer agents, leaving warfarin the anticoagulant of choice. Further studies are needed before the target-specific anticoagulants can be recommended for patients with cancer-associated thrombosis or heparin-induced thrombocytopenia. Concerns also persist about difficulties with the laboratory assessment of anticoagulant effect and the lack of a specific reversal agent. For these reasons, we anticipate that the vitamin K antagonists will continue to be important anticoagulants for years to come.

Full Text

Duke Authors

Cited Authors

  • Arepally, GM; Ortel, TL

Published Date

  • January 2015

Published In

Volume / Issue

  • 66 /

Start / End Page

  • 241 - 253

PubMed ID

  • 25587651

Electronic International Standard Serial Number (EISSN)

  • 1545-326X

International Standard Serial Number (ISSN)

  • 0066-4219

Digital Object Identifier (DOI)

  • 10.1146/annurev-med-051113-024633

Language

  • eng