New anticoagulants: Moving beyond the direct oral anticoagulants

Although anticoagulants have been in use for more than 80 years, heparin and vitamin K antagonists were the sole available options until recently. these agents revolutionized prevention treatment of thrombotic diseases, their has hampered by necessity coagulation monitoring bleeding complications resulting part from multiple sites action. Owing to advances basic science, animal models, epidemiology, arsenal expanded past two decades. This evolution yielded many novel compounds that target single enzymes. Initially, thrombin factor Xa targeted because critical roles coagulation. However, attention now shifted upstream reactions, particularly those catalyzed factors XIIa XIa, which are contact system. shift is predicated on epidemiological experimental evidence suggesting important thrombosis hemostasis. With goal developing a new class associated with lower risk currently agents, dozens drugs targeting system development. article focuses rationale, development, testing concentration reached or completed phase 2 evaluation at least one indication.