[New oral anticoagulants: prospects]

Two new oral anticoagulants are licensed in France for prevention for venous thromboembolism in patients undergoing hip or knee arthroplasty. Dabigatran (Pradaxa) inhibits the active site of thrombin. The 220-mg dose is recommended for the majority of patients whereas the 150-mg dose is reserved for patients also taking amiodarone and for those at higher risk for bleeding (patients with moderate renal insufficiency). Rivaroxan (Xarelto) inhibits reversibly the active site of fXa, the 10 mg-dose once daily is recommended started 6 to 12 hours after wound closure. The two drugs are given once daily in fixed doses without coagulation monitoring. However the aim of the new anticoagulants is to replaced VKAs particularly for prevention of stroke in patients with auricular fibrillation and for the treatment of venous thrombo-embolism. Recently published results in these two indications with dabigatran are very promising.