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Ximelagatran (Exanta or Exarta, H 376/95) is an anticoagulant that has been investigated extensively as a replacement for warfarin [1] that would overcome the problematic dietary, drug interaction, and monitoring issues associated with warfarin therapy.
Side effects may include bleeding, most commonly from the nose, gastrointestinal tract (GI) or genitourinary system. [2] Compared to the risk of bleeding with warfarin use, direct factor Xa inhibitors have a higher risk of GI bleeding, but lower risk of bleeding in the brain. [2]
Dabigatran is an oral direct thrombin inhibitor. Dabigatran (Pradaxa) was found to be noninferior to Warfarin in prevention of ischemic stroke, as well as intracranial hemorrhage risk and overall mortality for non-valvular atrial fibrillation according to the RE-LY trial. [9]
[8] [9] [10] It is used as an alternative to warfarin to prevent blood clots following hip or knee replacement and in those with a history of prior clots [8] [10] and does not require monitoring by blood tests [8] or dietary restrictions. [11] It is taken by mouth. [8] Common side effects include bleeding and nausea.
Compared to warfarin it has fewer interactions with other medications. [9] It is a direct thrombin inhibitor. [7] Dabigatran was approved for medical use in the United States in 2010. [6] It is on the World Health Organization's List of Essential Medicines. [10]
For a modern society, convenient and fast drug administration is the key to a good drug compliance. In 2008 the first direct Xa inhibitor was approved for clinical use. [ 8 ] Direct Xa inhibitors are just as efficacious as LMWH and warfarin but they are given orally and don't need as strict monitoring. [ 7 ]
[6] [10] Many pharmaceutical companies have attempted to develop orally bioavailable DTI drugs but dabigatran etexilate is the only one to reach the market. [9] In a 2012 meta-analysis dabigatran was associated with increased risk of myocardial infarction (MI) or ACS when tested against different controls in a broad spectrum of patients. [22]
Rivaroxaban, sold under the brand name Xarelto among others, is an anticoagulant medication (blood thinner) used to treat and prevent blood clots. [8] Specifically it is used to treat deep vein thrombosis and pulmonary emboli and prevent blood clots in atrial fibrillation and following hip or knee surgery. [8]