http://www.mdpi.com/journal/pharmaceuticals/special_issues/anticoagulants/ Dear Colleagues, After 60 years with warfarin and heparins as the only commonly used anticoagulants, the past 20 years have provided an impressive row of new agents. Low-molecular-weight heparins resulted in the first change of paradigm by enabling outpatient care of many patients with venous thromboembolism. The next shift should be the obviated need for routine laboratory monitoring and frequent dose adjustments of the oral anticoagulant. The purpose of this special issue is to assess the current status of the array of new anticoagulants at advanced stages of clinical trials. There are, however, still hurdles on the way, for example the question of reversal of such agents in emergency situations and how the higher cost of any new drug can be justified to the payers in view of the very inexpensive vitamin K antagonists, keeping in mind the considerable management costs associated with the latter. Prof. Sam Schulman, MD Guest Editor {snippet name="submission_info"} http://www.mdpi.com/1424-8247/5/2/155/ Dabigatran is an oral thrombin inhibitor which has been approved in several countries as an alternative to vitamin-K-antagonists for the prevention of stroke or embolism in atrial fibrillation patients. Dabigatran is introduced into clinical practice, although many issues regarding this drug are still unclear, like laboratory monitoring, use in elderly patients, drug- and food-interactions and use in patients with renal insufficiency. Additionally, there is no antidote for dabigatran. Thus, aim of the present review is to give an overview of concerns and unresolved issues concerning dabigatran. http://www.mdpi.com/1424-8247/5/2/155/ Fri, 03 Feb 2012 00:00:00 CET Pharmaceuticals 2012-02-03 5 2 Review 155 168 1424-8247 Concerns Regarding the Use of Dabigatran for Stroke Prevention in Atrial Fibrillation 2012-02-03 doi: 10.3390/ph5020155 Claudia Stöllberger Josef Finsterer http://www.mdpi.com/1424-8247/4/11/1475/ This is a review of key factors for pharmacy and therapeutics committees to consider when developing a therapeutic interchange (TI) program for venous thromboembolism (VTE) prophylaxis. Recent patient safety initiatives aimed at reducing the incidence of hospital-acquired VTE may increase the prescribing of thromboprophylactic agents recommended in VTE management guidelines. As a result, more pharmacy and therapeutics committees may consider TI programs for parenteral anticoagulants. However, the TI of anticoagulants appears challenging at this time. Firstly, the therapeutic equivalence of the commonly prescribed parenteral anticoagulants, enoxaparin, dalteparin and fondaparinux, has not been established. Secondly, because of the wide range of clinical indications for these anticoagulants, a blanket agent-specific TI program could lead to off-label use. Use of an indication-specific TI program could be difficult to manage administratively, and may cause prescribing confusion and errors. Thirdly, careful dosing and contraindications of certain parenteral anticoagulants in special patient populations, such as those with renal impairment, further impact the suitability of these agents for inclusion in TI programs. Finally, although TI may appear to offer lower drug-acquisition costs, it is important to determine its effect on all cost parameters and ultimately ensure that the care of patients requiring VTE prophylaxis is not compromised. http://www.mdpi.com/1424-8247/4/11/1475/ Mon, 07 Nov 2011 00:00:00 CET Pharmaceuticals 2011-11-07 4 11 Review 1475 1487 1424-8247 Therapeutic Interchange of Parenteral Anticoagulants: Challenges for Pharmacy and Therapeutics Committees 2011-11-07 doi: 10.3390/ph4111475 Alpesh Amin http://www.mdpi.com/1424-8247/3/12/3543/ Management of anticoagulation in elderly patients represents a particularly challenging issue. Indeed, this patient population is at high thromboembolic risk, but also at high hemorrhagic risk. Assessment of the benefit-risk balance of anticoagulation is the key point when decisions are made about introducing and/or continuing such treatments in the individual elderly patient. In order to maximise the safety of anticoagulation in the elderly, some specific considerations need to be taken into account, including renal insufficiency, modified pharmacodynamics of anticoagulants, especially vitamin K antagonists, and the presence of multiple comorbidities and concomitant medications. New anticoagulants could greatly simplify and possibly increase the safety of anticoagulation in the elderly in the near future. http://www.mdpi.com/1424-8247/3/12/3543/ Fri, 10 Dec 2010 00:00:00 CET Pharmaceuticals 2010-12-10 3 12 Review 3543 3569 1424-8247 Anticoagulation in the Elderly 2010-12-10 doi: 10.3390/ph3123543 Helia Robert-Ebadi Marc Righini