The Future of Oral Anticoagulants

Eventually, safer drugs with a wider therapeutic index may supplant warfarin. For example, ximelagatran is an oral thrombin inhibitor that may be a safe and effective alternative to warfarin therapy, at least for patients undergoing knee arthroplasty who have no preexisting liver disease (29). However, until the safety and effectiveness of newer anticoagulants is clear, warfarin and other vitamin K anticoagulants will be used extensively. The hypothesis that pharmacogenetic-based dosing will prevent iatrogenic hemorrhages during warfarin induction should be tested prospectively.

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