Les nouveaux antithrombotiques : une thérapeutique en mutation, des perspectives d'avenir New anticoagulant agents: the present and the future

The development of new antithrombotic molecules which induced an inhibition of activated factor X (fondaparinux), or a direct inhibition of thrombin, transforms the antithrombotic treatment. Fondaparinux (Arixtra ® ) shows an effectiveness and a safety as well as low weight molecular heparin in prevention of thromboembolic disease in orthopedic surgery and in the treatment of the pulmonary embolism and major venous thromboses. The lack of interaction shown in vitro and observed during clinical trials makes this molecule a product particularly easy-to-use in antithrombotic therapy. The introduction of an active direct antithrombin (Exanta ® ) per oral way opened very promising prospects in the replacement of the antivitamines K treatment. Its effectiveness and its tolerance appear very acceptable and the absence of food and drug interaction contributes to make it the ideal antithrombotic ambulatory treatment for tomorrow. Only its biological hepatic toxicity, not yet elucidated, currently delays a wider application. © 2006 Publie par Elsevier SAS pour la Societe de Reanimation de Langue Francaise. Mots cles : Nouveaux antithrombotiques ; Pentasaccharide ; Antithrombine ; Maladie thromboembolique