NEW ORAL ANTICOAGULANTS. Dabigatran – direct thrombin inhibitor Rivaroxiban – Xa inhibitor Apixaban – Xa inhibitor.
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Dabigatran – direct thrombin inhibitor
Rivaroxiban – Xa inhibitor
Apixaban – Xa inhibitor
The implication of the action of all of these new anticoagulants is that because their action is at the end of the coagulation cascade is that they are irreversible in the event
of anticoagulant induced bleeding unlike
warfarin for which reversal with Prothrombin
complex concentrates (PCC) and FFP
Rivaroxaban and Apixaban are factor Xa inhibitors only licenced currently as thromboprophylaxis for hip and knee replacement surgery however will be licenced for use in AF in 2013
The only reversal for any of the agents which is proven is the relatively short half life of ~ 15 hours other than haemodialysis which is impractical in the event of acute bleeding
HAPS haematology is currently developing tests to detect the concentration of all 3 of the new anticoagulants however to date there is no correlation with the level of the drug and its anticoagulant effect
For a drug to be considered superior to another it should be shown to offer advantages – greater efficacy, ease of use,.safety or cost effectiveness
The new anticoagulants are going to have an important role in thromboprophylaxis however the rush by drug companies to promote these expensive new agents has not been balanced by appropriate precautionary advice about the lack of an antidote in the event of bleeding, the lack of laboratory monitoring, the lack of clinical trialsin the patient group most likely tobe prescribed these agents ie, patients > 75 and with renal impairment