Thrombosis research
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We have made great strides in the diagnosis, treatment and prevention of venous thromboembolism (VTE). Despite these advances, however, questions remain. Perhaps the most important unmet need is the development and implementation of strategies to increase the uptake of guidelines for thromboprophylaxis. ⋯ VTE treatment also may be simplified with the new oral anticoagulants. With a rapid onset of action, these drugs may obviate the need for a parenteral anticoagulant for initial therapy. In addition, the new agents have the potential to streamline extended VTE therapy because, unlike vitamin K antagonists, they can be given in fixed doses without the need for coagulation monitoring.
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Since its discovery during the first half of the 20th century by biochemists at the University of Wisconsin, warfarin (along with other vitamin K antagonists) has remained the only oral anticoagulant available to patients at risk for thromboembolism. After nearly 6 decades in clinical practice, we have learned much about warfarin. ⋯ To that end, at least three novel anticoagulant compounds are in the late stages of development and several others are progressing through earlier phases of investigation. This review will summarize the latest clinical trial data pertinent to several newer antithrombotic agents and discuss recent developments that impact the safety and challenges associated with warfarin and other vitamin K antagonists (VKA).