Cardiology Letters 2023, 32(5):318-327

Perspectives of anticoagulation therapy in cardiovascular medicine

Sokol J¹, Nehaj F^{2, 3}, Chudej J¹, Svetlošák M^{2, 3}, Hlivák P^{2, 3}, Hatala R^{2, 3}

¹ Klinika hematológie a transfuziológie, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave

² Oddelenia arytmológie a kardiostimulácie, Národný ústav srdcovocievnych chorôb, a .s., Bratislava

³ Klinika kardiológie a angiológie, Slovenská zdravotnícka univerzita, Bratislava, Slovenská republika

The two last decades have witnessed a revolution in the field of anticoagulation. Direct oral anticoagulants (i.e., factor IIa- and factor Xa- inhibitors) progressively dominate clinical practice because of their favourable pharmacological profile and ease of use, particularly in venous thromboembolism (VTE) treatment and stroke prevention in atrial fibrillation. However, the residual risk of cardio- and cerebrovascular events, particularly in some critical settings, and the risk of major bleeding still represent unmet medical needs. As a result, ongoing research focuses on developing future anticoagulants with an improved safety profile. Several promising approaches to reduce the bleeding risk involve targeting the intrinsic (or contact activation) pathway of coagulation, with the goal of preventing thrombosis. Based on epidemiological data on hereditary factor deficiencies and preclinical studies factors XI and XII emerged as the most promising candidate targets. This review summarizes current knowledge on FXI and FXII inhibitors, with a particular focus on their pharmacological properties and potential clinical indications.

Keywords: anticoagulants; contact pathway; haemorrhage; therapy; thrombosis

Published: May 1, 2023  Show citation