A host of new oral anticoagulant agents, which could become much-needed replacements for warfarin and be used as alternatives to heparin, are under development. Two of these agents are now in phase 3 trials. Experts are cautious, however, following the failure of the first such agent, ximelagatran, to reach the US market because of liver-toxicity issues. Researchers are optimistic that at least 1 or 2 of the new compounds will succeed and provide patients who are taking warfarin with a much more userfriendly treatment.
The 2 agents furthest in development are the factor IIa inhibitor dabigatran (Boehringer Ingelheim) and the factor Xa inhibitor rivaroxaban (Bayer HealthCare and Ortho-McNeil Pharmaceuticals Inc). Several other companies also have orally available factor Xa inhibitors in earlier clinical development, including Bristol-Myers Squibb Co, Eli Lilly and Co, Yamanouchi Pharmaceutical Co, and DuPont Pharmaceuticals Co.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.