Future of anticoagulant therapy.

Prophylaxis and treatment of thromboembolic diseases is one of the main targets in medicine. Side effects and the necessity of dose adjustment limit the administration of coumarins and unfractionated heparin. Coumarins are therefore underused specially in the elderly population. Low-molecular-weight heparins, heparinoids, and direct thrombin inhibitors have overcome some of the limitations but they all have to be administered systemically. Synthetic systemically indirect and orally to apply direct factor Xa inhibitors and direct thrombin inhibitors are under development. They all aim to improve the underuse and the benefit/risk ratio for anticoagulant therapy. This overview describes the results of the recent studies of these inhibitors of blood coagulation. The future of the new anticoagulants will depend on the demonstration of their safety, efficacy, and health cost savings compared to the conventional antithrombotics.