[New advances in anticoagulation: is it time to forget about heparin and vitamin K antagonists? No]

The boost given to the new anticoagulants by the results of clinical trials is beginning to jeopardize the hegemony of coumadin and heparin therapy, the cornerstone of anticoagulation in the last 50 years. The safety and effectiveness of this new drug family with respect to warfarin and low-molecular weight heparin in the different facets of anticoagulation has been demonstrated, both in prophylaxis (total hip and knee replacement) and in treatment (atrial fibrillation and venous thromboembolic disease). These agents seem to offer superior convenience compared with their predecessors, although it is not clear whether this translates into greater treatment adherence when the data are analyzed in depth. Another drawback of these agents is their price, a consideration of major importance in the last few years, and which would only be offset by savings in the cost of the routine blood monitoring required for coumadin agents, available in hospitals. Finally, the populations excluded from the clinical trials should not be forgotten, as they are the last obstacle to be overcome and the basis for justifying the maintenance of heparin or coumadin therapy, depending on the case. The present article provides a more detailed analysis of these arguments, which serve as the basis for a reflection on the early retirement of classical anticoagulants.