New developments in acute anticoagulation therapy: what improvements over traditional heparin are on the horizon?

The quest for an orally active anticoagulant to replace warfarin sodium (Coumadin, Panwarfin, Sofarin) in long-term use has been disappointing. Most advances in oral anticoagulant therapy have involved more judicious and efficacious use of warfarin or one of its analogues. The area of heparin substitutes has experienced some exciting discoveries, with most current interest centered on low-molecular-weight heparins. Their efficacy, safety, and perhaps most important, clinical utility as a once- or twice-daily unmonitored medication have given them a meaningful role in current anticoagulation therapy. Third-generation anticoagulants, such as the direct thrombin inhibitors, are being investigated but are not ready for general clinical use. The role of ancrod (Arvin) from snake venom in patients with heparin-induced thrombocytopenic thrombosis has been clearly established. A practical issue that remains under discussion is the most suitable interaction between fiscal and clinical applications of these medications.