The introduction of novel oral anticoagulants, e.g. dabigatran, rivaroxaban, and apixaban, into clinical practice challenge well established concepts of anticoagulation pharmacotherapy, such as low molecular weight heparins and vitamin k antagonists.Therapeutic management using coumarins, for example, is complicated. Efficacy is, among others, influenced by diet, drug-drug interactions and genetic polymorphisms. Frequent monitoring is necessary and time consuming. Hospital pharmacists have always focused on this drug class, as it is associated with a high risk of drug-related problems and medication errors. The results of clinical landmark trials with these new drugs and ongoing research will undoubtedly lead to changes in the use of vitamin K antagonists and significantly influence the pharmacotherapy of relevant cardiovascular diseases.

 

These novel drugs unquestionably come with advantages. However, hospital pharmacists have to be aware of uncertainties (e.g. mode of reversal of anticoagulation, long-term safety data) and of the limitations (e.g. adherence) of these new anticoagulants.These anticoagulants are promising alternatives, but their widespread use in everyday clinical practice leave questions that still need to be answered. How will the safety record of these novel drugs compare to that of half-a-century safety data of Warfarin? Will there still be a place for vitamin K antagonists in future anticoagulation? Is one newer agent superior to the others? Will drug costs be a hindering factor for treatment access?

 

As key stakeholders in assessing and selecting drugs for in-hospital use, hospital pharmacists need to acquire an in-depth knowledge of these novel anticoagulants, and be competent to comment on their safety and in addition contribute to patient education.

 Dr. Eichinger-Hasenauer has undertaken research to investigate the mechanism of action of procoagulants and anticoagulants, and the pathophysiology of the coagulation system in women, and evaluates the risk factors for thrombotic disease and biomarkers of the coagulation system. In 1992, she initiated one of the worldwide largest study in patients with venous thrombosis, the Austrian Study on Recurrent Venous Thromboembolism. She is the local principal investigator of several interventional studies in patients with venous thromboembolism and atrial fibrillation and an internationally recognized expert in designing and conducting clinical studies. She is chairman-elect of the Scientific and Standardization Subcommittee of the International Society on Thrombosis and Haemostasis and recipient of several international awards.

 

 

Affiliation: Guy’s and St Thomas’ NHS Foundation Trust