New antithrombotic drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Abstract

This article focuses on new antithrombotic drugs that are in or are entering phase 3 clinical testing. Development of these new agents was prompted by the limitations of existing antiplatelet, anticoagulant, or fibrinolytic drugs. Addressing these unmet needs, this article (1) outlines the rationale for development of new antithrombotic agents; (2) describes the new antiplatelet, anticoagulant, and fibrinolytic drugs; and (3) provides clinical perspectives on the opportunities and challenges faced by these novel agents.

Figures

Figure 1.

New antiplatelet drugs. PAR = protease-activated receptor.

Figure 2.

Sites of action of new anticoagulants in more advanced stages of development. NAPc2 = nematode anticoagulant peptide c2.

Figure 3.

Classification of new anticoagulants. Indirect anticoagulants act in an AT-dependent fashion or exert their effect via the protein C pathway. Direct anticoagulants do not require a plasma cofactor. Instead, these agents directly target a specific coagulation enzyme. AT = antithrombin. See Figure 2 legend for expansion of other abbreviation.