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New antithrombotic agents—insights from clinical trials

Nature Reviews Cardiology volume 7, pages 498–509 (2010)Cite this article

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Abstract

Antithrombotic agents are the cornerstones of therapy for thrombosis. The compositions of arterial and venous clots differ, rendering antiplatelet agents more effective for arterial thrombosis and anticoagulants more effective for venous disease. Despite taking acetylsalicylic acid, some patients with arterial disease experience thrombotic events. The addition of the ADP-receptor antagonist clopidogrel to therapeutic regimens containing acetylsalicylic acid improves outcomes in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. However, clopidogrel has several limitations, including variable absorption, drug–drug interactions and genetic factors that lead to reduced generation of the active metabolite, and a delayed onset and offset of action. A search for new ADP-receptor inhibitors has yielded drugs such as prasugrel, ticagrelor, and cangrelor. For patients with venous thrombosis, the coumarins have been the only available oral anticoagulants for more than 60 years. Despite their effectiveness in preventing and treating thromboembolism, coumarins have well-documented limitations, including drug–drug and drug–dietary interactions, a narrow therapeutic range, and inconvenience and cost of monitoring therapy. A search for new oral anticoagulants has yielded drugs such as dabigatran etexilate, rivaroxaban, and apixaban. In this article, we review these new antithrombotic agents and provide plausible explanations for the results of phase III randomized controlled trials of these drugs.

Key Points

  • New antithrombotic agents tested in phase III randomized controlled trials include the oral ADP-receptor antagonists prasugrel and ticagrelor, the intravenous ADP-receptor antagonist cangrelor, and the oral anticoagulants dabigatran etexilate, apixaban and rivaroxaban

  • Prasugrel and ticagrelor act more rapidly than clopidogrel, and are more potent and effective in preventing major cardiovascular events in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention

  • More-potent ADP-receptor antagonists might potentially increase the risk of bleeding compared with clopidogrel, but those whose action is reversible (ticagrelor and cangrelor) might potentially reduce periprocedural bleeding

  • New oral anticoagulants have more-rapid onset and offset than warfarin, low potential for drug–food or drug–drug interactions, and a predictable response that eliminates the need for routine coagulation monitoring

  • New oral anticoagulants lack an antidote and, since they are in part excreted in the urine, they have the potential to increase bleeding in patients with renal dysfunction

  • The relative efficacy of new ADP-receptor antagonists and new oral anticoagulants will only be determined by direct randomized comparisons

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Figure 1: Inhibition of platelet activation by ADP-receptor antagonists.
Figure 2: Action of new oral anticoagulants on the coagulation cascade.

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References

  1. Mackman, N. Triggers, targets and treatments for thrombosis. Nature 451, 914–918 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Eikelboom, J. W. & Hirsh, J. Combined antiplatelet and anticoagulant therapy: clinical benefits and risks. J. Thromb. Hemost. 5 (Suppl. 1), 255–263 (2007).

    Article  CAS  Google Scholar 

  3. Baigent, C. et al. for the Antithrombotic Trialists' (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373, 1849–1860 (2009).

    Article  PubMed  Google Scholar 

  4. Patrono, C., García Rodríguez, L. A., Landolfi, R. & Baigent, C. Low-dose aspirin for the prevention of atherothrombosis. N. Engl. J. Med. 353, 2373–2383 (2005).

    Article  CAS  PubMed  Google Scholar 

  5. Hankey, G. J. & Eikelboom, J. W. Aspirin resistance. BMJ 328, 477–479 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Savi, P. & Herbert, J. M. Clopidogrel and ticlopidine: P2Y12 adenosine diphosphate-receptor antagonists for the prevention of atherothrombosis. Semin. Thromb. Hemost. 31, 174–183 (2005).

    Article  CAS  PubMed  Google Scholar 

  7. Bertrand, M. E., Rupprecht, H. J., Urban, P., Gershlick, A. H. for the CLASSICS Investigators. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 102, 624–629 (2000).

    Article  CAS  PubMed  Google Scholar 

  8. Yusuf, S. et al. for the CURE Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N. Engl. J. Med. 345, 494–502 (2001).

    Article  CAS  PubMed  Google Scholar 

  9. Sabatine, M. S. et al. for the CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N. Engl. J. Med. 352, 1179–1189 (2005).

    Article  CAS  PubMed  Google Scholar 

  10. Chen, Z. M. et al. for the COMMIT Collaborative Group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366, 1607–1621 (2005).

    Article  CAS  PubMed  Google Scholar 

  11. Mehta, S. R. & Yusuf, S. for the CURE Study Investigators. The Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial program; rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease. Eur. Heart J. 21, 2033–2041 (2000).

    Article  CAS  PubMed  Google Scholar 

  12. Sabatine, M. S. et al. for the CLARITY-TIMI 28 Investigators. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA 294, 1224–1232 (2005).

    Article  CAS  PubMed  Google Scholar 

  13. Anderson, J. L. et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 116, e148–e304 (2007).

    PubMed  Google Scholar 

  14. King, S. B. 3rd et al. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation 117, 261–295 (2008).

    Article  PubMed  Google Scholar 

  15. Lip, G. Y. et al. for the European Society of Cardiology Working Group on Thrombosis. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Thromb. Hemost. 103, 13–28 (2010).

    Article  CAS  Google Scholar 

  16. Raju, N. C., Eikelboom, J. W. & Hirsh, J. Platelet ADP-receptor antagonists for cardiovascular disease: past, present and future. Nat. Clin. Pract. Cardiovasc. Med. 5, 766–780 (2008).

    Article  CAS  PubMed  Google Scholar 

  17. Cairns, J. A. & Eikelboom, J. Clopidogrel resistance: more grist for the mill. J. Am. Coll. Cardiol. 51, 1935–1937 (2008).

    Article  CAS  PubMed  Google Scholar 

  18. Mega, J. L. et al. Cytochrome p-450 polymorphisms and response to clopidogrel. N. Engl. J. Med. 360, 354–362 (2009).

    Article  CAS  PubMed  Google Scholar 

  19. Simon, T. et al. for the FAST-MI Investigators. Genetic determinants of response to clopidogrel and cardiovascular events. N. Engl. J. Med. 360, 363–375 (2009).

    Article  CAS  PubMed  Google Scholar 

  20. Trenk, D. et al. Cytochrome P450 2C19 681G>A polymorphism and high on-clopidogrel platelet reactivity associated with adverse 1-year clinical outcome of elective percutaneous coronary intervention with drug-eluting or bare-metal stents. J. Am. Coll. Cardiol. 51, 1925–1934 (2008).

    Article  CAS  PubMed  Google Scholar 

  21. Gilard, M., Arnaud, B., Le Gal, G., Abgrall, J. F. & Boschat, J. Influence of omeprazol on the antiplatelet action of clopidogrel associated to aspirin. J. Thromb. Hemost. 4, 2508–2509 (2006).

    Article  CAS  Google Scholar 

  22. Siller-Matula, J. M. et al. Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel. Am. Heart J. 157, 148.e1–148.e5 (2009).

    Article  Google Scholar 

  23. Juurlink, D. N. Proton pump inhibitors and clopidogrel: putting the interaction in perspective. Circulation 120, 2310–2312 (2009).

    Article  PubMed  Google Scholar 

  24. O'Donoghue, M. L. et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet 374, 989–997 (2009).

    Article  CAS  PubMed  Google Scholar 

  25. Mehta, S. R. & Van de Werf, F. A randomized comparison of a clopidogrel high loading and maintenance dose regimen versus standard dose and high versus low dose aspirin in 25,000 patients with acute coronary syndromes: Results of the CURRENT OASIS 7 Trial. Presented at the European Society of Cardiology Congress 2009.

  26. Hirsh, J. Oral anticoagulant drugs. N. Engl. J. Med. 324, 1865–1875 (1991).

    Article  CAS  PubMed  Google Scholar 

  27. Farid, N. A. et al. The disposition of prasugrel, a novel thienopyridine, in humans. Drug Metab. Dispos. 35, 1096–1104 (2007).

    Article  CAS  PubMed  Google Scholar 

  28. Brandt, J. T. et al. A comparison of prasugrel and clopidogrel loading doses on platelet function: magnitude of platelet inhibition is related to active metabolite formation. Am. Heart J. 153, 66.e9–66.e16 (2007).

    Article  Google Scholar 

  29. Jernberg, T. et al. Prasugrel achieves greater inhibition of platelet aggregation and a lower rate of non-responders compared with clopidogrel in aspirin-treated patients with stable coronary artery disease. Eur. Heart J. 27, 1166–1173 (2006).

    Article  CAS  PubMed  Google Scholar 

  30. Brandt, J. T. et al. Common polymorphisms of CYP2C19 and CYP2C9 affect the pharmacokinetic and pharmacodynamic response to clopidogrel but not prasugrel. J. Thromb. Hemost. 5, 2429–2436 (2007).

    Article  CAS  Google Scholar 

  31. Mega, J. L. et al. Cytochrome P450 genetic polymorphisms and the response to prasugrel: relationship to pharmacokinetic, pharmacodynamic, and clinical outcomes. Circulation 119, 2553–2560 (2009).

    Article  CAS  PubMed  Google Scholar 

  32. Wiviott, S. D. et al. for the TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 357, 2001–2015 (2007).

    Article  CAS  PubMed  Google Scholar 

  33. A comparison of prasugrel and clopidogrel in acute coronary syndrome subjects (TRILOGY ACS). ClinicalTrials.gov identifier: NCT00699998 [online], (2010).

  34. Husted, S. et al. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur. Heart J. 27, 1038–1047 (2006).

    Article  CAS  PubMed  Google Scholar 

  35. Storey, R. F. et al. Inhibition of platelet aggregation by AZD6140, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes. J. Am. Coll. Cardiol. 50, 1852–1856 (2007).

    Article  CAS  PubMed  Google Scholar 

  36. Gurbel, P. A. et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation 120, 2577–2585 (2009).

    Article  CAS  PubMed  Google Scholar 

  37. Gurbel, P. A. et al. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation 121, 1188–1199 (2010).

    Article  CAS  PubMed  Google Scholar 

  38. Wallentin, L. et al. for the PLATO Investigators. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 361, 1045–1057 (2009).

    Article  CAS  PubMed  Google Scholar 

  39. Serebruany, V. L. & Atar, D. The PLATO trial: do you believe in magic? Eur. Heart J. 31, 764–767 (2010).

    Article  PubMed  Google Scholar 

  40. Storey, R. F., Oldroyd, K. G. & Wilcox, R. G. Open multicenter study of the P2T receptor antagonist AR-C69931MX assessing safety, tolerability and activity in patients with acute coronary syndromes. Thromb. Hemost. 85, 401–407 (2001).

    Article  CAS  Google Scholar 

  41. Harrington, R. A. et al. Platelet inhibition with cangrelor in patients undergoing PCI. N. Engl. J. Med. 361, 2318–2329 (2009).

    Article  CAS  PubMed  Google Scholar 

  42. Bhatt, D. L. et al. for the CHAMPION PLATFORM Investigators. Intravenous platelet blockade with cangrelor during PCI. N. Engl. J. Med. 361, 2330–2341 (2009).

    Article  CAS  PubMed  Google Scholar 

  43. Kastrati, A. & Ndrepepa, G. Cangrelor—a champion lost in translation? N. Engl. J. Med. 361, 2382–2384 (2009).

    Article  CAS  PubMed  Google Scholar 

  44. Steinhubl, S. R. et al. Transitioning patients from cangrelor to clopidogrel: pharmacodynamic evidence of a competitive effect. Thromb. Res. 121, 527–534 (2008).

    Article  CAS  PubMed  Google Scholar 

  45. Weitz, J. I. New oral anticoagulants in development. Thromb. Hemost. 103, 62–70 (2010).

    Article  CAS  Google Scholar 

  46. Weitz, J. I. Emerging anticoagulants for the treatment of venous thromboembolism. Thromb. Hemost. 96, 274–284 (2006).

    Article  CAS  Google Scholar 

  47. Eriksson, B. I., Quinlan, D. J. & Weitz, J. I. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development. Clin. Pharmacokinet. 48, 1–22 (2009).

    Article  CAS  PubMed  Google Scholar 

  48. Weitz, J. I. Emerging anticoagulants for the treatment of venous thromboembolism. Thromb. Hemost. 96, 274–284 (2006).

    Article  CAS  Google Scholar 

  49. Connolly, S. J. et al. for the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 361, 1139–1151 (2009).

    Article  CAS  PubMed  Google Scholar 

  50. Andreotti, F., Testa, L., Biondi-Zoccai, G. G. & Crea, F. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur. Heart J. 27, 519–526 (2006).

    Article  CAS  PubMed  Google Scholar 

  51. Hart, R. G., Pearce, L. A. & Aguilar, M. I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann. Intern. Med. 146, 857–867 (2007).

    Article  PubMed  Google Scholar 

  52. Eriksson, B. I. et al. for the RE-MODEL Study Group. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J. Thromb. Hemost. 5, 2178–2185 (2007).

    Article  CAS  Google Scholar 

  53. Ginsberg, J. S. et al. for the RE-MOBILIZE Writing Committee. Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery. J. Arthroplasty 24, 1–9 (2009).

    Article  PubMed  Google Scholar 

  54. Eriksson, B. I. et al. for the RE-NOVATE Study Group. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 370, 949–956 (2007).

    Article  CAS  PubMed  Google Scholar 

  55. Dabigatran etexilate compared with enoxaparin in prevention of VTE following total hip arthroplasty. ClinicalTrials.gov identifier: NCT00657150 [online], (2010).

  56. Schulman, S. et al. for the RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N. Engl. J. Med. 361, 2342–2352 (2009).

    Article  CAS  PubMed  Google Scholar 

  57. RE-DEEM dose finding study for dabigatran etexilate in patients with acute coronary syndrome.ClinicalTrials.gov identifier: NCT00621855 [online], (2010).

  58. Lassen, M. R. et al. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N. Engl. J. Med. 361, 594–604 (2009).

    Article  CAS  PubMed  Google Scholar 

  59. Lassen, M. R. et al. for the ADVANCE-2 Investigators. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet 375, 807–815 (2010).

    Article  CAS  PubMed  Google Scholar 

  60. Study of an investigational drug for the prevention of thrombosis-related events following hip replacement surgery. ClinicalTrials.gov identifier: NCT00423319 [online], (2010).

  61. Alexander, J. H. et al. for the APPRAISE Steering Committee and Investigators. Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial. Circulation 119, 2877–2885 (2009).

    Article  PubMed  Google Scholar 

  62. Phase III acute coronary syndrome (APPRAISE-2). ClinicalTrials.gov identifier: NCT00831441 [online], (2010).

  63. Eriksson, B. I. et al. for the RECORD1 Study Group. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N. Engl. J. Med. 358, 2765–2775 (2008).

    Article  CAS  PubMed  Google Scholar 

  64. Kakkar, A. K. et al. for the RECORD2 Investigators. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 372, 31–39 (2008).

    Article  CAS  PubMed  Google Scholar 

  65. Lassen, M. R. et al. for the RECORD3 Investigators. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N. Engl. J. Med. 358, 2776–2786 (2008).

    Article  CAS  PubMed  Google Scholar 

  66. Turpie, A. G. et al. for the RECORD4 Investigators. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet 373, 1673–1680 (2009).

    Article  CAS  PubMed  Google Scholar 

  67. Buller, H. R. Once-daily oral rivaroxaban versus placebo in the long-term prevention of recurrent symptomatic venous thromboembolism. The EINSTEIN-Extension Study. Presented at the 51st American Society of Hematology Meeting 2009.

  68. Bayer AG. Phase III EINSTEIN-Extension study of Bayer's rivaroxaban shows significant benefit in the prevention of secondary symptomatic VTE Bayer: Science for Better Life [online], (2010).

  69. Mega, J. L. et al. for the ATLAS ACS–TIMI 46 study group. Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS–TIMI 46): a randomised, double-blind, phase II trial. Lancet 374, 29–38 (2009).

    Article  CAS  PubMed  Google Scholar 

  70. An efficacy and safety study for rivaroxaban in patients with acute coronary syndrome. ClinicalTrials.gov identifier: NCT00809965 [online], (2010).

  71. Dabigatran etexilate compared with enoxaparin in prevention of VTE following total hip arthroplasty. ClinicalTrials.gov identifier: NCT00657150 [online], (2010).

  72. Phase III study testing efficacy and safety of oral dabigatran etexilate versus warfarin for 6 month treatment of acute symptomatic VTE. ClinicalTrials.gov identifier: NCT00680186 [online], (2010).

  73. Secondary prevention of venous thromboembolism. ClinicalTrials.gov identifier: NCT00329238 [online], (2010).

  74. Twice-daily oral direct thrombin inhibitor dabigatran etexilate in the long-term prevention of recurrent symptomatic VTE. ClinicalTrials.gov identifier: NCT00558259 [online], (2010).

  75. Study of apixaban for the prevention of thrombosis-related events in patients with acute medical illness (ADOPT). ClinicalTrials.gov identifier: NCT00457002 [online], (2010).

  76. Efficacy and safety study of apixaban in the treatment of deep vein thrombosis or pulmonary embolism. ClinicalTrials.gov identifier: NCT00643201 [online], (2010).

  77. Efficacy and safety study of apixaban for extended treatment of deep vein thrombosis or pulmonary embolism. ClinicalTrials.gov identifier: NCT00633893 [online], (2010).

  78. A phase III study of apixaban in patients with atrial fibrillation (AVERROES). ClinicalTrials.gov identifier: NCT00496769 [online], (2010).

  79. Apixaban for the prevention of stroke in subjects with atrial fibrillation (ARISTOTLE). ClinicalTrials.gov identifier: NCT00412984 [online], (2010).

  80. Venous Thromboembolic event (VTE) prophylaxis in medically ill patients (MAGELLAN). ClinicalTrials.gov identifier: NCT00571649 [online], (2010).

  81. Oral direct factor Xa inhibitor rivaroxaban in patients with acute symptomatic deep-vein thrombosis without pulmonary embolism: Einstein-DVT evaluation. ClinicalTrials.gov identifier: NCT00440193 [online], (2010).

  82. Oral direct factor Xa inhibitor rivaroxaban in patients with acute symptomatic pulmonary embolism with or without symptomatic deep-vein thrombosis: Einstein-PE evaluation. ClinicalTrials.gov identifier: NCT00439777 [online], (2010).

  83. An efficacy and safety study for rivaroxaban in patients with acute coronary syndrome. ClinicalTrials.gov identifier: NCT00809965 [online], (2010).

  84. Efficacy and safety of rivaroxaban for the prevention of stroke in subjects with non-valvular atrial fibrillation. ClinicalTrials.gov identifier: NCT00494871 [online], (2010).

  85. Randomized, double-blind study comparing once-daily oral rivaroxaban with adjusted-dose oral warfarin for the prevention of stroke in subjects with non-valvular atrial fibrillation. ClinicalTrials.gov identifier: NCT00403767 [online], (2010).

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Authors and Affiliations

  1. Department of Medicine, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, L8L 2X2, ON, Canada

    Jeremy S. Paikin & John W. Eikelboom

  2. David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, L8L 2X2, ON, Canada

    Jack Hirsh

  3. University of British Columbia, GLD Health Care Center, 2775 Laurel Street, Room 9113, Vancouver, V5Z 1M9, BC, Canada

    John A. Cairns

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J. S. Paikin, J. A. Cairns and J. Hirsh contributed to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments. J. W. Eikelboom contributed to discussion of content for the article and reviewed and edited the manuscript before submission.

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J. W. Eikelboom has received consulting fees and/or honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Corgenix, Daiichi Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Hemoscope, McNeil Consumer Healthcare, and Sanofi-Aventis; and has received grants and/or in-kind support from Accumetrics, AspirinWorks, Bayer, Boehringer Ingelheim, Bristol-Myer Squibb, Corgenix, Dade Behring, GlaxoSmithKline, and Sanofi-Aventis. The other authors declare no competing interests.

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Paikin, J., Eikelboom, J., Cairns, J. et al. New antithrombotic agents—insights from clinical trials. Nat Rev Cardiol 7, 498–509 (2010). https://doi.org/10.1038/nrcardio.2010.101

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