[New oral anticoagulants. Significance for dermatology and phlebology]

Venous thromboembolism and atrial fibrillation are common and are treated with vitamin K antagonists in 1.7% of the total population in the western world. The limitations of the vitamin K antagonists and of heparin have led to the development of new oral drugs. These drugs inhibit thrombin or factor Xa and can be given in a fixed dosage; they have a broad therapeutic margin and relatively few drug interactions. Specific risks and problems also are associated with the new drugs such as interference with common coagulation tests without being able to draw any conclusion as to the actual bleeding risk and the lack of specific antidotes. No established coagulation monitoring is available. The article gives reviews the current knowledge and provides practical advice on how to use the new drugs for the approved indications such as knee and hip replacement, therapy of deep venous thrombosis and of atrial fibrillation. Beyond that, recommendations are given for perioperative management and for change of treatment.