Bleeding Disorders Surgery at High Risk of Bleeding

(VTE) and in some countries for the treatment of acute coronary syndromes. Idraparinux, a subcutaneous, longacting, indirect Factor Xa inhibitor, is in development. Direct inhibition of thrombin or Factor Xa with synthetic, small molecules is an attractive strategy for the development of novel anticoagulants. After the withdrawal of ximelagatran, dabigatran is now the furthest advanced oral, direct thrombin inhibitor, and an extensive phase III clinical trial programme (the RE VOLUTION trials) has recently determined its efficacy and safety in the prevention of VTE in major orthopaedic surgery. Direct Factor Xa inhibitors in development that show clinical promise in various indications include rivaroxaban, apixaban, betrixaban, LY-517717, YM150, and DX-9065a and its derivative Du-176b. Of these rivaroxaban and apixaban are the furthest advanced. Rivaroxaban has a favourable efficacy and safety profile, relative to enoxaparin, for the prevention of VTE after major orthopaedic surgery as shown in the RECORD trials. The results of trials of rivaroxaban for the treatment of proximal deep vein thrombosis are expected soon. It is likely that these new anticoagulants will revolutionize oral anticoagulant therapy. BLEEDING DISORDERS