Anticoagulant therapy

Anticoagulant therapy is used to prevent unwanted clotting, for example in high risk groups after previous deep vein thrombosis or pulmonary embolism.

Anticoagulation is routinely used in the treatment of established thromboembolism.

Historically, warfarin and heparin have been the main agents used but newer agents include:

Direct Thrombin Inhibitors: Bivalirudin, argatroban, and dabigatran are direct thrombin inhibitors; these inhibit the cleavage of fibrinogen to fibrin by thrombin. All products are renally metabolized.

Direct Factor 10a Inhibitors: These include rivaroxaban, apixaban, edoxaban, and betrixaban. Mechanism of action involves inhibition of the cleavage of prothrombin to thrombin by binding directly to factor 10a. These products are only orally administered.

The terms direct oral anticoagulants (DOACs), new oral anticoagulants (NOACs), or target-specific oral anticoagulants (TSOACs) refer to those oral anticoagulants which specifically inhibit factors 2a (thrombin) or 10a.

Reference

1. British National Formulary (BNF); NICE Evidence Services. Anticoagulants.