ximelagatran and coumarin

Old burdens and new perspectives of the long-term anticoagulant therapy. Long-term anticoagulant therapy (LAT) has increasingly improved the prognosis in various diseases thus becoming an indispensable tool in our day-to-day therapeutic arsenal. However its use is influenced by various uncertainty factors. The optimal range of anticoagulation can unfortunately only be partially achieved due to the several factors influencing it. Thromboembolic and bleeding episodes occur mainly at times when the state of anticoagulation diverges from the ideally set therapeutic range. Quality of the ongoing therapy can only partially be improved by increasing the frequency of the controls. This however is also inherent partly in the treatment indication and also in the personality of the given patient (compliance). Heparin preparations are rarely used for long-term anticoagulant therapy due to the inevitable injectable form of administration. The more easily applicable LMWH-s' actions are also influenced by several uncertainty factors. In cases of idiopathic deep vein thrombosis, extension of the LAT therapy could be beneficial and is recommended beyond 6 months in order to prevent recurrence of the acute event and postthrombotic syndrome, irrespective of the proof of the genetic predisposition. Several clinical observations suggest that LAT could hinder propagation of malignant tumors and this presumption has already been supported by experimental data. The favourable effect has primarily been associated with and experienced with the use of LMWH-s. Prolonged LAT may even change the perspectives of thrombolytic therapy in venous thrombosis, improving its late efficacy. A new and simply applicable anticoagulant may help further spreading of LAT.

Topics: Anticoagulants; Azetidines; Benzylamines; Coumarins; Drug Administration Schedule; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Humans; International Normalized Ratio; Neoplasms; Patient Compliance; Thromboembolism; Thrombolytic Therapy; Thrombosis