[Oral anticoagulant drugs in clinical practice]

In current clinical practice, oral anticoagulant therapy is one of the most widely employed treatments in order to prevent embolic events in cardiovascular diseases. This therapy is bound to become more and more employed because of increasing mean age of general population and related increase of clinical settings which may require anticoagulation. Nowadays, available drugs for oral anticoagulation are vitamin K antagonists which inhibit the coagulation factors depending upon this vitamin for their synthesis. In this review we will examine: --their mechanism of action and its clinical implications related with the initial phase of therapy and the likelihood of side effects as cutaneous necrosis; --their pharmacokinetics which explain most of drug interactions; --affecting therapy factors: age of patients, impaired absorption, genetic polymorphisms of cytochrome P450, drug resistance, coagulation factors defects, particular clinical situations, vitamin K dietary intake; --different properties of various anticoagulant drugs; --toxicity; --problems related to monitoring anticoagulation intensity. At last, we will present the new pharmacological perspectives offered by direct inhibitors of the coagulation factors.