[Oral anticoagulants: new horizons]

Anticoagulation is at the dawn of a new era. Dominated for a long time by heparins and vitamin K antagonists, the anticoagulant arsenal is growing up. With a direct and reversible action targeting specifically thrombin (IIa) or factor Xa, these new synthetic agents, given orally, have large therapeutic windows and predictable pharmacokinetics. Their properties allow them to avoid tight monitoring improving patient comfort and security. Pharmacological studies are promising. Regarding some indications, these new drugs seem better than "classical" anticoagulants either in efficacy or in security terms. However, they increase the hemorrhagic risk and particularly in fragile populations like elderly patients or with renal insufficiency. Only few assays are available in the laboratory to evaluate their effects and no antidote is currently on the market. The way to new anticoagulant therapies is now open. In the future, specific indications of vitamin K antagonists, heparins and these new molecules will have to be determined.