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Kyyak S, Jari A, Heimes D, Heider J, Kämmerer PW. Platelet-rich fibrin ensures hemostasis after single-tooth removal under factor Xa inhibitors - a clinical prospective randomized split-mouth study. Clin Oral Investig 2023; 27:7275-7283. [PMID: 37864605 PMCID: PMC10713775 DOI: 10.1007/s00784-023-05317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/08/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES In this prospective, double-blinded, randomized split-mouth study, the local hemostatic effect of platelet-rich fibrin (PRF) inserted into the extraction socket in patients taking factor Xa (FXa) inhibitors (apixaban, rivaroxaban, edoxaban) was compared to a hemostatic gelatine sponge (GS) as the "therapeutic gold standard" without withdrawal of oral anticoagulant therapy. MATERIALS AND METHODS Single-tooth extraction was conducted under local anesthesia in n = 21 patients using a split-mouth design (42 teeth). Using a double-blind approach, the extraction socket on one side of the jaw was filled with PRF and on the other with a GS. Bleeding was assessed immediately after surgery, in 30 min, 1 h, 1.5 h, and on follow-up appointments in 24 h and on the 7th day. RESULTS In 67% of cases, mild postoperative oozing could be stopped 30-90 min after tooth extraction via gauze pressure without any delayed bleeding. Concerning bleeding events, there was no difference among the PRF and GS groups and no significant difference among rivaroxaban, apixaban, and edoxaban (all p > 0.15). CONCLUSION PRF and GS are reliable hemostatic methods in postextraction sockets of patients taking FXa inhibitors. CLINICAL RELEVANCE Consequently, there is no need to discontinue FXa inhibitors because of a single-tooth removal, eliminating the risk of thrombus formation.
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Affiliation(s)
- Solomiya Kyyak
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Ali Jari
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Diana Heimes
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Julia Heider
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Launay M, Nasser Y, Maubert I, Chaux AC, Delavenne X. Accidental apixaban intoxication in a 23-month-old child: a case report. BMC Pediatr 2020; 20:546. [PMID: 33278889 PMCID: PMC7718703 DOI: 10.1186/s12887-020-02448-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/30/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Direct oral anticoagulants, such as apixaban, are increasingly used in everyday practice in order to treat or prevent thromboembolic diseases. To date, there is no available data about apixaban pharmacokinetics in children, and no intoxication has previously been described. CASE PRESENTATION A 23-month-old boy, with no medical history, was admitted to the emergency department 2 h after accidentally ingesting 40 mg apixaban and 0.75 mg digoxin. No adverse event was observed. Digoxin trough level was within therapeutic values. Apixaban blood concentration increased up to 1712 μg/L at H + 6 (1000-2750 μg/L using 2-5 mg/kg of apixaban in adults). The terminal half-life was 8.2 h (6-15 h in adults). The rapid elimination may explain the absence of bleeding despite high concentrations. CONCLUSIONS Despite an important intake of apixaban and a real disturbance in routine coagulation assays, no clinical sign of bleeding was observed, perhaps due to wide therapeutic range of apixaban. It may also be explained by its rapid elimination. Considering the high Cmax and a possible enteroenteric recycling, the use of activated charcoal should be considered in such situations in order to prevent eventual bleeding.
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Affiliation(s)
- Manon Launay
- Laboratoire de Pharmacologie-Toxicologie-Gaz du Sang, CHU Saint-Etienne, Albert Raimond avenue, Saint-Etienne, France.
| | - Yara Nasser
- Laboratoire de Pharmacologie-Toxicologie-Gaz du Sang, CHU Saint-Etienne, Albert Raimond avenue, Saint-Etienne, France
| | - Isabelle Maubert
- Laboratoire d'analyses médicales, CH Emile Roux, le Puy-en-Velay, France
| | - Anne-Cécile Chaux
- Service de Médecine Intensive et Réanimation Pédiatrique, CHU Saint-Etienne, Saint-Etienne, France
| | - Xavier Delavenne
- Laboratoire de Pharmacologie-Toxicologie-Gaz du Sang, CHU Saint-Etienne, Albert Raimond avenue, Saint-Etienne, France
- INSERM U1059, Dysfonctions Vasculaires et de l'Hémostase, Université de Lyon, Saint-Etienne, France
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3
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Costantinides F, Rizzo R, Pascazio L, Maglione M. Managing patients taking novel oral anticoagulants (NOAs) in dentistry: a discussion paper on clinical implications. BMC Oral Health 2016; 16:5. [PMID: 26822674 PMCID: PMC4731944 DOI: 10.1186/s12903-016-0170-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/25/2016] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this paper is to contribute to the discussion on how to approach patients taking new orally administered anticoagulants (NOAs) dabigatran etexilate (a direct thrombin inhibitor), rivaroxaban and apixaban (factor Xa inhibitors), before, during and after dental treatment in light of the more recent knowledges. Discussion In dentistry and oral surgery, the major concerns in treatment of patients taking direct thrombin inhibitors and factor Xa inhibitors is the risk of haemorrhage and the absence of a specific reversal agent. The degree of renal function, the complexity of the surgical procedure and the patient’s risk of bleeding due to other concomitant causes, are the most important factors to consider during surgical dental treatment of patients taking NOAs. For patients requiring simple dental extraction or minor oral surgery procedures, interruption of NOA is not generally necessary, while an higher control of bleeding and discontinuation of the drug (at least 24 h) should be requested before invasive surgical procedures, depending on renal functionality. Summary The clinician has to consider that the number of patients taking NOAs is rapidly increasing. Since available data are not sufficient to establish an evidence-based dental management, the dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban and apixaban.
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Affiliation(s)
- Fulvia Costantinides
- School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Roberto Rizzo
- School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Lorenzo Pascazio
- Unit of Geriatrics, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Michele Maglione
- School of Specialization in Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Xu C, Ren Y. Molecular modeling studies of [6,6,5] Tricyclic Fused Oxazolidinones as FXa inhibitors using 3D-QSAR, Topomer CoMFA, molecular docking and molecular dynamics simulations. Bioorg Med Chem Lett 2015; 25:4522-8. [PMID: 26343829 DOI: 10.1016/j.bmcl.2015.08.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/22/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
Coagulation factor Xa (Factor Xa, FXa) is a particularly promising target for novel anticoagulant therapy. The first oral factor Xa inhibitor has been approved in the EU and Canada in 2008. In this work, 38 [6,6,5] Tricyclic Fused Oxazolidinones were studied using a combination of molecular modeling techniques including three-dimensional quantitative structure-activity relationship (3D-QSAR), molecular docking, molecular dynamics and Topomer CoMFA (comparative molecular field analysis) were used to build 3D-QSAR models. The results show that the best CoMFA model has q(2)=0.511 and r(2)=0.984, the best CoMSIA (comparative molecular similarity indices analysis) model has q(2)=0.700 and r(2)=0.993 and the Topomer CoMFA analysis has q(2)=0.377 and r(2)=0.886. The results indicated the steric, hydrophobic, H-acceptor and electrostatic fields play key roles in models. Molecular docking and molecular dynamics explored the binding relationship of the ligand and the receptor protein.
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Affiliation(s)
- Cheng Xu
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai 201418, China
| | - Yujie Ren
- School of Chemical and Environmental Engineering, Shanghai Institute of Technology, Shanghai 201418, China.
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Broussalis E, Anna W, Trinka E, Mutzenbach S, Killer M. Latest developments in anticoagulant drug discovery. Drug Discov Today 2014; 19:921-35. [PMID: 24607728 DOI: 10.1016/j.drudis.2014.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/11/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
Thromboembolic diseases have increased in number over the past years. Oral anticoagulants impair the formation and progression of thrombotic processes and are therefore of great importance in the treatment of these diseases. Until recently, vitamin K antagonists were used to block the coagulation system. But these agents display a lot of interactions besides their narrow therapeutic range and have potential risk of hemorrhage complications. Therefore, other factors of the coagulation cascade are currently being explored as therapeutic targets for the development of novel anticoagulants. This review will provide an overview of new drugs promising more effectiveness in the treatment of arterial and venous embolism. Furthermore, pharmacodynamics and drug interactions regarding new anticoagulants will be reported.
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Affiliation(s)
- Erasmia Broussalis
- Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Department of Neuroradiology, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria; Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Research Institute for Neurointervention, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria; Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Department of Neurology, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria.
| | - Wallner Anna
- Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Research Institute for Neurointervention, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria
| | - Eugen Trinka
- Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Department of Neurology, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria
| | - Sebastian Mutzenbach
- Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Department of Neurology, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria
| | - Monika Killer
- Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Research Institute for Neurointervention, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria; Paracelsus Medical University Salzburg, Christian-Doppler-Klinik, Department of Neurology, Ignaz-Harrerstrasse 79, 5020 Salzburg, Austria
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6
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Tang AW, Greer I. A systematic review on the use of new anticoagulants in pregnancy. Obstet Med 2013; 6:64-71. [PMID: 27757159 DOI: 10.1177/1753495x12472642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/17/2022] Open
Abstract
New anticoagulants such as direct factor Xa inhibitors and direct thrombin inhibitors have been recently developed, but their experience in pregnancy is limited. This review therefore aims to systematically search for studies on the use of these newer anticoagulants in pregnancy and the puerperal period. Searches were performed on electronic databases MEDLINE (from 1966), EMBASE (from 1974) and the Cochrane Library, until October 2011 using terms of 'pregnancy', 'puerperium', 'breastfeeding' and names of specific anticoagulants. The search yielded 561 citations and 11 studies (10 on fondaparinux, 1 on ximelagatran) were included. Newer anticoagulants (fondaparinux, hirudin and argatroban) on the limited evidence appear not to have adverse pregnancy outcomes, but there is currently no experience of new oral anticoagulants (rivaroxaban, apixaban, betrixaban or dabigatran) use in pregnancy. There is a need for reporting on new oral anticoagulation use in pregnancy to provide more information about the safety and risks to the fetus in utero.
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Affiliation(s)
- Ai-Wei Tang
- Fetal Medicine Unit, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool L8 7SS, UK
| | - Ian Greer
- Faculty of Health & Life Sciences, University of Liverpool, Foundation Building, Liverpool L69 7ZX, UK
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Preventing venous thromboembolism in major orthopaedic surgery. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31828b2b07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Firriolo FJ, Hupp WS. Beyond warfarin: the new generation of oral anticoagulants and their implications for the management of dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:431-41. [DOI: 10.1016/j.oooo.2011.10.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/17/2011] [Accepted: 10/13/2011] [Indexed: 01/19/2023]
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10
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Davis EM, Packard KA, Knezevich JT, Campbell JA. New and emerging anticoagulant therapy for atrial fibrillation and acute coronary syndrome. Pharmacotherapy 2012; 31:975-1016. [PMID: 21950643 DOI: 10.1592/phco.31.10.975] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract Thrombosis is an underlying cause of many cardiovascular disorders, and generation of thrombi in the arterial circulation can lead to unstable angina, myocardial infarction, or ischemic stroke. Antithrombotic therapy is widely used, with proven benefit to prevent ischemic stroke and thromboembolic events in patients with atrial fibrillation (AF) or to prevent further ischemic complications in patients with acute coronary syndrome (ACS). Traditional anticoagulants (including unfractionated heparin, low-molecular-weight heparin, and warfarin) and antiplatelet agents (including aspirin, clopidogrel, and prasugrel) are typically used for these indications. Limitations to their use include variable pharmacokinetic and pharmacodynamic profiles, inability to inhibit fibrin-bound thrombin, risk of heparin-induced thrombocytopenia, delayed onset of action, numerous drug interactions, need for substantial laboratory monitoring and dosage titrations, hyporesponsiveness or resistance, hypersensitivity, adverse events, and bleeding. To overcome some of the limitations of traditional agents, new antithrombotic agents under development are highly selective for specific coagulation factors blocking the synthesis of thrombin. Clinicians must have an understanding of the new anticoagulants to aid in the selection of appropriate therapies for patients. We describe the most relevant phases II and III clinical trials that evaluated several recent emerging anticoagulant drugs for use in patients with AF or ACS. The advantages of many new agents include predictable pharmaco-dynamic response and pharmacokinetic parameters, allowing for fixed oral dosing with no need for laboratory monitoring. For patients with AF, dabigatran is already approved for the prevention of stroke and systemic embolism, rivaroxaban appears to be an effective alternative to warfarin in high-risk patients, and apixaban may also be an effective alternative to aspirin in patients unable to take warfarin. Otamixaban shows promise as an intravenous alternative for patients with ACS in the acute care setting. Likewise, rivaroxaban, dabigatran, and darexaban with or without dual antiplatelet therapy may be beneficial for secondary prevention of ischemic events in patients with ACS.
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Affiliation(s)
- Estella M Davis
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska 68178, USA
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11
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Juchem G, Weiss DR, Knott M, Senftl A, Förch S, Fischlein T, Kreuzer E, Reichart B, Laufer S, Nees S. Regulation of coronary venular barrier function by blood borne inflammatory mediators and pharmacological tools: insights from novel microvascular wall models. Am J Physiol Heart Circ Physiol 2012; 302:H567-81. [DOI: 10.1152/ajpheart.00360.2011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We hypothesized that postcapillary venules play a central role in the control of the tightness of the coronary system as a whole, particularly under inflammatory conditions. Sandwich cultures of endothelial cells and pericytes of precapillary arteriolar or postcapillary venular origin from human myocardium as models of the respective vascular walls (sandwich cultures of precapillary arteriolar or postcapillary venular origin) were exposed to thrombin and components of the acutely activatable inflammatory system, and their hydraulic conductivity ( LP) was registered. LP of SC-PAO remained low under all conditions (3.24 ± 0.52·10−8cm·s−1·cmH2O−1). In contrast, in the venular wall model, PGE2, platelet-activating factor (PAF), leukotriene B4 (LTB4), IL-6, and IL-8 induced a prompt, concentration-dependent, up to 10-fold increase in LP with synergistic support when combined. PAF and LTB4 released by metabolically cooperating platelets, and polymorphonuclear leucocytes (PMNs) caused selectively venular endothelial cells to contract and to open their clefts widely. This breakdown of the barrier function was preventable and even reversible within 6–8 h by the presence of 50 μM quercetin glucuronide (QG). LTB4 synthesis was facilitated by biochemical involvement of erythrocytes. Platelets segregated in the arterioles and PMNs in the venules of blood-perfused human myocardium (histological studies on donor hearts refused for heart transplantation). Extrapolating these findings to the coronary microcirculation in vivo would imply that the latter's complex functionality after accumulation of blood borne inflammatory mediators can change rapidly due to selective breakdown of the postcapillary venular barrier. The resulting inflammatory edema and venulo-thrombosis will severely impair myocardial performance. The protection afforded by QG could be of particular relevance in the context of cardiosurgical intervention.
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Affiliation(s)
- Gerd Juchem
- Department of Cardiac Surgery, University of Munich (Ludwig Maximilians University), Munich
| | - Dominik R. Weiss
- Department of Transfusion Medicine and Hemostaseology, University of Erlangen-Nuremberg (Friedrich Alexander University), Erlangen
| | - Maria Knott
- Department of Physiology, University of Munich (Ludwig Maximilians University), Munich
| | - Anton Senftl
- Department of Physiology, University of Munich (Ludwig Maximilians University), Munich
| | - Stefan Förch
- Department of Physiology, University of Munich (Ludwig Maximilians University), Munich
| | - Theodor Fischlein
- Department of Cardiac Surgery, Hospital Nuremberg South, Nuremberg; and
| | - Eckart Kreuzer
- Department of Cardiac Surgery, University of Munich (Ludwig Maximilians University), Munich
| | - Bruno Reichart
- Department of Cardiac Surgery, University of Munich (Ludwig Maximilians University), Munich
| | - Stefan Laufer
- Department of Pharmaceutical Chemistry, University of Tuebingen (Eberhard Karls University), Munich, Germany
| | - Stephan Nees
- Department of Physiology, University of Munich (Ludwig Maximilians University), Munich
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Samamaa MM, Conard J, Flaujac C, Combe S, Horellou MH. Hétérogénéité pharmacologique des nouveaux anticoagulants. ACTA ACUST UNITED AC 2011; 36 Suppl 1:S10-5. [DOI: 10.1016/s0398-0499(11)70002-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Toschi V, Lettino M. Inhibitors of propagation of coagulation: factors V and X. Br J Clin Pharmacol 2011; 72:563-80. [PMID: 21545479 PMCID: PMC3195734 DOI: 10.1111/j.1365-2125.2011.04001.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 04/05/2011] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular diseases are still the most important cause of morbidity and mortality in western countries and antithrombotic treatment is nowadays widely used. Drugs able to reduce coagulation activation are the treatment of choice for a number of arterial and/or venous thromboembolic conditions. Some of the drugs currently used for this purpose, such as heparins (UFH or LMWH) and VKA, have limitations consisting of a narrow therapeutic window and an unpredictable response with the need of laboratory monitoring in order to assess their efficacy and safety. These drawbacks have stimulated an active research aimed to develop new drugs able to act on single factors involved in the coagulation network, with predictable response. Intense experimental and clinical work on new drugs has focused on synthetic agents, which could preferably be administered orally and at fixed doses. The most advanced clinical development with new anticoagulants has been achieved for those inhibiting FXa and some of them, like fondaparinux, are already currently used in clinical practice. Other agents, such as rivaroxaban, apixaban, otamixaban and edoxaban are under development and have already been studied or are currently under investigation in large scale phase III clinical trials for prevention and treatment of venous thromboembolism, atrial fibrillation and acute coronary syndromes. Some of them have proved to be more effective than conventional therapy. Data on some agents inhibiting FVa are still preliminary and some of these drugs have so far been considered only in patients with disseminated intravascular coagulation secondary to sepsis.
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Affiliation(s)
- Vincenzo Toschi
- Department of Hematology and Blood Transfusion, Thrombosis Center, San Carlo Borromeo Hospital, Milan, Italy.
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14
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Zhao HP, Zhang XS, Xiang BR. Discontinued drugs in 2010: cardiovascular drugs. Expert Opin Investig Drugs 2011; 20:1311-25. [PMID: 21870899 DOI: 10.1517/13543784.2011.611500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This perspective is a paper discussing drugs dropped from clinical development in the previous years. Specifically, this paper focuses on 16 cardiovascular drugs discontinued in 2010 after reaching Phase I - III clinical trials. Information for this perspective is mainly derived from a search of Pharmaprojects.
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Affiliation(s)
- Hong-ping Zhao
- Center for Instrumental Analysis, China Pharmaceutical University, Nanjing, Key Laboratory of Drug Quality Control & Pharmacovigilance, Ministry of Education, Jiangsu 210009, People's Republic of China.
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Yoshikawa K, Yoshino T, Yokomizo Y, Uoto K, Naito H, Kawakami K, Mochizuki A, Nagata T, Suzuki M, Kanno H, Takemura M, Ohta T. Design, synthesis and SAR of novel ethylenediamine and phenylenediamine derivatives as factor Xa inhibitors. Bioorg Med Chem Lett 2011; 21:2133-40. [DOI: 10.1016/j.bmcl.2011.01.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 12/16/2022]
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