Les nouveaux anticoagulants oraux

Two new classes of oral anticoagulants are now available: direct thrombin inhibitors: dabigatran; direct factor Xa inhibitors: rivaroxaban, apixaban, and others. These drugs have a rapid absorption and action, are administered at fixed doses and do not require regular monitoring coagulation tests. In large randomized trials, they have been equivalent to heparins and warfarin in the prevention and treatment of thromboembolic disease, or in preventing stroke and embolism in atrial fibrillation. Subgroup analyses have been performed for people older than 75 years, where a dose reduction is recommended. Moreover, their renal excretion may limit their clinical use: contraindicated if CrCl < 30 ml/min; doses must be reduced if CrCl is between 30 and 50 ml/min.