Milestone 

Anticoagulants

Anticoagulant drugs are used to prevent and treat thrombotic disorders in millions of patients worldwide. This Milestone plots the history of anticoagulant drugs on an interactive Timeline, starting with the discovery and clinical trials of heparin and warfarin. The synthesis of low-molecular-weight heparins enabled more convenient, outpatient treatment of thrombosis. Since 2000, the development of direct oral factor Xa and thrombin inhibitors as well as antidotes to reverse the effects of these drugs has revolutionized the practice of anticoagulation. Nevertheless, the delicate cost–benefit balance between bleeding and prevention of clotting continues to drive research into novel agents and optimal dosing regimens.

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This Milestone is editorially independent, produced with financial support from a third party. About this content.

Milestone animations

Animation | The history of warfarin
This animation illustrates the history and development of warfarin, and its evolution from rat poison to widespread clinical anticoagulant drug.
 

Animation | Drug targets in the coagulation cascade
This animation illustrates the clotting factors involved in thrombus formation, and how these factors can be pharmacologically targeted using heparin, warfarin, and direct thrombin and factor Xa inhibitors for clinical anticoagulation.
 

Milestone podcasts

Interview with Jack Hirsh
Listen to Professor Jack Hirsh discuss his involvement in anticoagulant research, including the development of the international normalized ratio.

Interview with Harry Büller
Listen to Professor Harry Büller discuss clinical trials on the prevention and treatment of thrombosis and how medical practice has evolved.

Interview with Jeffrey Weitz
Listen to Professor Jeffrey Weitz discuss the ongoing challenges in anticoagulant therapy and the developments that are on the horizon.
 

Related multimedia

 Poster | Anticoagulant drugs
 Nature Reviews Cardiology

 Animation | The evolution of oral anticoagulants
 Nature Reviews Cardiology & Nature Reviews Drug Discovery

 Poster & Animation | The 50-year quest to replace warfarin
 Nature Reviews Drug Discovery

 PrimeView | Venous thrombosis
 Nature Reviews Disease Primers