Recent pharmacological advances for treating venous thromboembolism: are we witnessing the demise of warfarin?

Abstract

SummaryVitamin K antagonists, such as warfarin, have been the mainstay in treatment and prophylaxis of venous thromboembolism. However, warfarin has many disadvantages including a narrow therapeutic window, numerous potential drug interactions, modulation of effect by alcohol and foods containing vitamin K and genetic variation in metabolism of warfarin, all of which contribute to the unpredictability of therapy. This has provided the impetus for developing new oral anticoagulants with a rapid onset of action, wide therapeutic window, predictable and reversible action, with few drug or dietary interactions, no requirement for routine coagulation monitoring or dose adjustment and acceptable cost. No single agent incorporates all these characteristics, but new factor Xa and direct thrombin inhibitors are being introduced into clinical practice that fulfil some of these aims. Here, we briefly discuss the current practice with its limitations and pitfalls, and then review important trials that have launched new oral anticoagulants into clinical practice.

Use of non-vitamin K antagonists oral anticoagulants in atrial fibrillation patients on dialysis

“…This might result from warfarin accumulation in these patients as CYP2C9 is downregulated in patients with ERSD ( 7 , 9 ). And warfarin needs close monitoring of prothrombin time ( 10 ), deteriorates vascular calcification ( 11 ), and sometimes induces anticoagulant-related nephropathy ( 12 ).…”

Risk assessment and prophylaxis of venous thromboembolism in surgical inpatients: improving adherence to national guidelines

“…Risk factors for VTE include prolonged immobility during and after surgery, major trauma, malignancy, inherited thrombophilias, old age, and obesity. [ 4 ]…”