Important advances in anticoagulation therapy have been made in the past few years. Many novel agents, including oral factor Xa inhibitors and direct thrombin inhibitors, are currently under investigation as alternatives to vitamin K antagonists in various clinical settings. This focus issue features four Review articles, written by leading experts, in which new clinical trial data and controversies in the field are discussed and put into context.
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RESEARCH HIGHLIGHT
Anticoagulation therapies: Warfarin vs aspirin in HF
Bryony M. Mearns
doi:10.1038/nrcardio.2012.77
Nature Reviews Cardiology 9, 372 (2012)
NEWS AND VIEWS
Venous thromboembolism: EINSTEIN transforms anticoagulant therapy in acute PE
Jeffrey A. Kline & Donald M. Yealy
doi:10.1038/nrcardio.2012.65
Nature Reviews Cardiology 9, 378-380 (2012)
REVIEWS
Oral direct factor Xa inhibitors for stroke prevention in atrial fibrillation
Katherine P. Cabral & Jack Ansell
doi:10.1038/nrcardio.2012.19
Nature Reviews Cardiology 9, 384-390 (2012)
Oral direct factor Xa inhibitors, particularly apixaban and rivaroxaban, are novel and promising alternatives to warfarin for stroke prevention in patients with atrial fibrillation. Drs Cabral and Ansell review the data from clinical trials of these drugs, and also discuss the challenges of reversing their anticoagulant effects, interactions with other medications, patient compliance, and therapeutic monitoring.
Oral factor Xa inhibitors for the long-term management of ACS
James W. Wisler & Richard C. Becker
doi:10.1038/nrcardio.2012.18
Nature Reviews Cardiology 9, 391-400 (2012)
Novel, oral, direct inhibitors of factor Xa are valuable additions to anticoagulation therapy in patients with various thrombotic disorders, but have shown mixed results in trials for secondary prevention in patients with an acute coronary syndrome. Drs Wisler and Becker review the available data, with particular emphasis on the phase III APPRAISE 2 and ATLAS ACS 2–TIMI 51 trials of apixaban and rivaroxaban.
Direct thrombin inhibitors in cardiovascular disease
Kyle A. Arsenault, Jack Hirsh, Richard P. Whitlock & John W. Eikelboom
doi:10.1038/nrcardio.2012.61
Nature Reviews Cardiology 9, 401-413 (2012)
Direct inhibitors of thrombin are a novel class of anticoagulant. The authors critically review the data from clinical trials on the use of the parenteral and oral forms of these drugs for primary or secondary prevention or treatment in patients with acute coronary syndrome, atrial fibrillation, or venous thromboembolism, or those undergoing percutaneous coronary intervention or orthopedic surgery.
Anticoagulation during pregnancy in patients with a prosthetic heart valve
Jose M. Castellano, Rajeev L. Narayan, Prashant Vaishnava & Valentin Fuster
doi:10.1038/nrcardio.2012.69
Nature Reviews Cardiology 9, 414-423 (2012)
Oral anticoagulation therapy is the most effective strategy for preventing thromboembolic complications in pregnant women with prosthetic heart valves. However, this therapy is associated with increased fetal morbidity and mortality. The authors discuss the controversies surrounding the choice of prosthetic heart valve in women of childbearing age and the advantages and disadvantages of various anticoagulation strategies during pregnancy.
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