ABSTRACT
The medical treatment of venous thromboembolism dates back to the 1940s, when unfractionated heparin (UFH) and vitamin K antagonists (VKAs) were first used for this indication. The treatment changed little until low-molecular weight heparin (LMWH) was introduced about 20 years ago. The introduction of LMWH allowed outpatient treatment of most patients with deep-vein thrombosis (DVT) and, more recently, a substantial proportion of patients with pulmonary embolism (PE). A pentasaccharide is the smallest entity of heparin that can bind to and change the conformation of antithrombin for selective inhibition of factor Xa. One such pentasaccharide, fondaparinux, has recently been approved for several indications requiring anticoagulation. Several orally available, selective coagulation factor inhibitors are presently in advanced phase of clinical trials. This chapter reviews the above-mentioned anticoagulant agents and their profile in established venous thromboembolism.
