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Ximelagatran—Promises and Concerns
Victor Gurewich, MD
JAMA. 2005;293:736-739.
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Vitamin K ("Koagulation") antagonists have been the sole oral anticoagulants available for 60 years, ever since Link1 identified the components in spoiled sweet clover responsible for bleeding in cattle. Originally developed as a rat poison, vitamin K antagonists such as warfarin are used successfully for the prevention of venous and arterial thromboembolism for a wide range of clinical indications, including atrial fibrillation (AF), venous thromboembolism (VTE), coronary artery disease, some orthopedic procedures, and congenital or acquired thrombophilia. Since both age and obesity increase the risk of atrial fibrillation2 and VTE, the need for anticoagulants is increasing.
Warfarin treatment is complicated by several inherent problems that have limited its use. These include delayed onset of its antithrombotic action, narrow therapeutic index, unpredictable and variable pharmacological response, and the mandatory regular laboratory monitoring to control its anticoagulant effect and minimize risk of serious bleeding. In addition, numerous drugs, certain . . . [Full Text of this Article]
Author Affiliation: Vascular Research Laboratory, Beth Israel Deaconess Hospital Medical Center, Boston, Mass.
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