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Clinical Studies with Anticoagulants that Have Changed Clinical Practice
Jack Hirsh1, Tim A C de Vries2,3,4, John W Eikelboom1,5,6
1Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Seminars in Thrombosis and Hemostasis
|January 5, 2023
Summary
Anticoagulant therapy has evolved significantly, with direct oral anticoagulants now preferred for most uses due to their safety and efficacy. Further research is needed to optimize dosing for underrepresented patient groups in clinical trials.
Area of Science:
- Pharmacology and Clinical Medicine
Background:
- Anticoagulant therapy is crucial for preventing and treating thromboembolism.
- Historical development of anticoagulants includes heparin, vitamin K antagonists, and direct oral anticoagulants.
Purpose of the Study:
- To review key clinical trials of anticoagulants from the 1960s to 2022.
- To examine the evolution of anticoagulant therapy and obstacles in clinical implementation.
Main Methods:
- Historical analysis of landmark clinical trials.
- Review of evidence supporting the adoption of new anticoagulant classes.
Main Results:
- Early anticoagulant studies had design limitations but were influential.
- Low-molecular-weight heparin offered advantages over unfractionated heparin.
- Direct oral anticoagulants demonstrate comparable safety and efficacy to vitamin K antagonists without routine monitoring.
Conclusions:
- Anticoagulant therapy has advanced, with direct oral anticoagulants representing a major improvement.
- Further studies are necessary to refine direct oral anticoagulant dosing in specific populations.
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