Emerging anticoagulants for venous thromboembolism prevention
Review published in Am J Health Syst Pharm (2010)
Abstract
PURPOSE: To discuss the advantages and disadvantages of currently available anticoagulants, describe the characteristics of the ideal anticoagulant, and compare and contrast the mechanisms of action, pharmacokinetics, administration, efficacy, safety, and potential for drug interactions of currently available and emerging anticoagulants for prevention of venous thromboembolism (VTE). SUMMARY: Despite the proven efficacy of currently available agents for VTE prevention, several shortcomings exist that may prevent their use under various circumstances. These include administration by injection, narrow therapeutic index, unpredictable pharmacokinetics and pharmacodynamics, need for laboratory monitoring, risk for bleeding, and drug interactions. The ideal anticoagulant would overcome many of these issues; in particular, it would be available as an oral formulation. Dabigatran, an oral direct thrombin (factor IIa) inhibitor, and apixaban and rivaroxaban, oral direct factor Xa inhibitors, represent new agents for anticoagulation that may address many of these issues. While not available as an oral agent, desirudin is an additional option and offers increased flexibility when a non-heparin-based injectable anticoagulant is desired. Current literature indicates that these agents generally do not require laboratory monitoring and are safe and effective for VTE prevention in clinical studies of patients undergoing major orthopedic surgery. CONCLUSION: The development of new anticoagulants that may overcome limitations of existing agents represents an opportunity to further improve outcomes in patients at risk for VTE in orthopedic surgery.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
To discuss the advantages and disadvantages of currently available anticoagulants, describe the characteristics of the ideal anticoagulant, and compare and contrast the mechanisms of action, pharmacokinetics, administration, efficacy, safety, and potential for drug interactions of currently available and emerging...
Why This Matters for Hirudotherapy
This review article examined the mechanisms of action, pharmacokinetics, administration, efficacy, safety, and potential for drug interactions of currently available and emerging anticoagulants for prevention of venous thromboembolism (VTE), including dabigatran, apixaban, rivaroxaban, and desirudin. Its relevance to ASH and hirudotherapy is direct and well-founded: desirudin is recombinant hirudin derived from the medicinal leech (Hirudo medicinalis), and the abstract discusses it as a non-heparin-based injectable option offering increased flexibility, with clinical studies indicating these agents are generally safe and effective without routine laboratory monitoring in patients undergoing major orthopedic surgery. This article helps situate a leech-secretome-derived anticoagulant within the broader landscape of modern antithrombotic pharmacotherapy. An honest caveat is that this is a narrative review focused on conventional drug therapy for surgical VTE prophylaxis; it does not address leech therapy itself or the broader leech secretome beyond the pharmaceutical formulation of desirudin.
Citation
Emerging anticoagulants for venous thromboembolism prevention.
Trujillo TC · Am J Health Syst Pharm, 2010
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