Anticoagulants

Renal dysfunction and atrial fibrillation (AF) share common risk factors and often coexist. Here, the authors discuss the risks and benefits of use of vitamin K antagonists (VKAs) and non-VKA oral anticoagulants for thromboprophylaxis in patients with coexistent AF and renal dysfunction.

The anticoagulant rivaroxaban is the first approved direct inhibitor of the serine protease factor Xa. This article presents the history of rivaroxaban's development, from its discovery to the preclinical and clinical studies, and also provides a brief overview of other oral anticoagulants in advanced clinical development.

Venous thrombosis and its potentially debilitating or even fatal consequences can pose diagnostic and therapeutic challenges. Here, Mackman and colleagues discuss not only the clinical implications of thrombosis but also new insights into thrombogenesis and how to inhibit this process.

Disseminated intravascular coagulation can be caused by various infectious and non-infectious insults, such as sepsis and trauma, respectively. It is characterized by the widespread activation of coagulation and, depending on the underlying condition, can manifest as bleeding and/or thrombosis.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with cancer. Treatment with low-molecular-weight heparin is the recommended first-line approach for treating cancer patients with newly diagnosed VTE. The authors of this Review discuss the optimal duration of anticoagulant therapy, treatment of recurrent VTE, the role of vena cava filters, the effects of VTE and its treatment on quality of life, and the impact of anticoagulants on survival.

Portal vein thrombosis (PVT) is a fairly common complication of liver cirrhosis. In this Review, the authors discuss the evidence regarding the management of PVT in patients with liver cirrhosis and propose an exploratory and preliminary algorithm, noting the limited data and low-quality evidence available to date.

The authors of this Review present what is known about the pathophysiology of increased coagulation in patients with cancer and how it applies to pancreatic carcinoma. The relationship between the activation of coagulation or symptomatic thromboembolic disease and the development of pancreatic carcinoma is explored. In addition, the relationship between thromboembolic disease and prognosis, and the rationale and evidence for the use of anticoagulants in patients with pancreatic carcinoma are considered.

The association between coagulation and the immune system has been increasingly recognised to have a role in the development of inflammatory rheumatic diseases. The fact that the risk of venous thromboembolism is increased in patients with rheumatoid arthritis (RA) and citrullinated fibrinogen is an early autoantigen in RA indicates an adaptive immune response to coagulation factors in inflammatory rheumatic diseases. In this article, Hoppe and Dörner describes the pathophysiology of an induced procoagulatory state in inflammatory rheumatic diseases, discussing the roles of endothelial cell and platelet activation, and coagulation and fibrinolytic systems, and providing insights into future research for innovative therapeutic interventions.