Abstract
Warfarin has a long history as a golden standard in oral anticoagulation medication. In recent years, however, new anticoagulants have appeared, aspiring to take over the helm.
Development has focused mainly on direct inhibitors of thrombin and direct inhibitors of Factor Xa. The greatest progress in the registration process has been achieved by dabigatran (Pradaxa), followed by rivaroxaban (Xarelto) and apixaban (Eliquis).
They are peroral agents with pointed effect, i.e. they block individual factors of the coagulation cascade - Factor Xa (xabans) and Factor II (gatrans), without any monitoring being necessary, but without any possibility to administer a specific antidote. They are already commonly used in the prevention of thromboembolic disease (TED) in orthopaedics and are starting to be administered as part of the prevention of systemic embolization in patients with atrial fibrillation.
Registration for the purpose of treatment of acute venous thrombosis, pulmonary embolism and secondary prophylaxis of these events is approaching. Other molecules are currently at the stage of clinical trials (for instance, edoxaban, betrixaban, otomixaban)