TY - JOUR
T1 - Direct thrombin inhibitors for the treatment of venous thromboembolism
T2 - Analysis of the dabigatran versus warfarin clinical trial
AU - Liem, Timothy K.
AU - DeLoughery, Thomas G.
N1 - Funding Information:
VITAMIN-K ANTAGONISTS HAVE been the mainstay of long-term oral anticoagulation since their discovery in the early part of the 20 th century. Dicoumarol, the first commercially available vitamin-K antagonist, was isolated from sweet clover, an alfalfa-like feed additive, after observations were made that some farm animals would develop hemorrhagic complications when they received contaminated feed. 1 Although dicoumarol was not widely utilized due to poorly predictable dosing effects, a more potent derivative was soon developed by the original investigators, with funding from the Wisconsin Alumni Research Foundation. This led to the commercial release of warfarin, first as a rodent poison in 1948, then as a therapeutic anticoagulant in 1954. To this day, warfarin continues to be an effective antithrombotic agent for long-term treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as stroke prevention in atrial fibrillation. 2,3
PY - 2011/9
Y1 - 2011/9
N2 - Vitamin-K antagonists have played a dominant role in the long-term management of patients with venous thromboembolism, and large trials from the past decade reinforced warfarin's effectiveness as an intermediate-duration and extended-duration anticoagulant. However, promising new oral direct thrombin inhibitors are proving to be at least as effective and as safe as the vitamin-K antagonists, without the associated hepatic toxicity that was seen with earlier orally administered direct thrombin inhibitors. This article reviews the recently published Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism clinical trial, and discusses the limitations and clinical applicability of the trial, especially in comparison with vitamin-K antagonists and the recently studied oral direct factor Xa inhibitors, rivaroxaban and apixaban.
AB - Vitamin-K antagonists have played a dominant role in the long-term management of patients with venous thromboembolism, and large trials from the past decade reinforced warfarin's effectiveness as an intermediate-duration and extended-duration anticoagulant. However, promising new oral direct thrombin inhibitors are proving to be at least as effective and as safe as the vitamin-K antagonists, without the associated hepatic toxicity that was seen with earlier orally administered direct thrombin inhibitors. This article reviews the recently published Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism clinical trial, and discusses the limitations and clinical applicability of the trial, especially in comparison with vitamin-K antagonists and the recently studied oral direct factor Xa inhibitors, rivaroxaban and apixaban.
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U2 - 10.1053/j.semvascsurg.2011.11.003
DO - 10.1053/j.semvascsurg.2011.11.003
M3 - Article
C2 - 22153026
AN - SCOPUS:83455219511
SN - 0895-7967
VL - 24
SP - 157
EP - 161
JO - Seminars in Vascular Surgery
JF - Seminars in Vascular Surgery
IS - 3
ER -