Angelika Bátorová
Parenteral heparin and oral coumarin preparations represent the standard anticoagulants widely used in the treatment and prevention of arterial and venous thromboembolism. Despite high efficacy these medicaments have limitations which become to be more apparent with current widening of the indications for either primary or indefinite and even lifelong secondary thromboprophylaxis. There is a need for new effective and safe medicaments with specific antithrombotic action, oral administration and convenient dosing without monitoring. During the last decade new anithrombotics have been developed either blocking selectively one coagulation enzyme or inhibiting particular step in coagulation cascade. Direct thrombin inhibitors and selective anti Xa inhibitor prentasacharide fondaparinux were the first new generation antithrombotics approved for clinical use. The first oral thrombin inhibitor ximelagatran licenced was withdrawed due to hepatotoxicity. At present phase III clinical trials with numerous new generation antithrombotics are underway, near to approval are direct thrombin inhibitor dabigatran and selective factor Xa inhibitors rivaroxaban and apixaban.