NEW DEVELOPMENTS IN ACUTE ANTICOAGULATION THERAPY - WHAT IMPROVEMENTSOVER TRADITIONAL HEPARIN ARE ON THE HORIZON

The quest for an orally active anticoagulant to replace warfarin sodiu m (Coumadin, Panwarfin, Sofarin) in long-term use has been disappointi ng. Most advances in oral anticoagulant therapy have involved more jud icious and efficacious use of warfarin or one of its analogues. The ar ea of heparin substitutes has experienced some exciting discoveries, w ith most current interest centered on low-molecular-weight heparins. T heir efficacy, safety, and perhaps most important, clinical utility as a once- or twice-daily unmonitored medication have given them a meani ngful role in current anticoagulation therapy. Third-generation antico agulants, such as the direct thrombin inhibitors, are being investigat ed but are not ready for general clinical use. The role of ancrod (Arv in) from snake venom in patients with heparin-induced thrombocytopenic thrombosis has been clearly established A practical issue that remain s under discussion is the most suitable interaction between fiscal and clinical applications of these medications.