Pharmacotherapy of deep-venous thrombosis: current status and future perspective

Anticoagulation is the main therapy for acute deep-vein thrombosis (DVT) of the limbs. Over the last five decades there has been little progress in the development of oral anticoagulant therapies. However, recently this area has been experiencing a rapidly changing situation thanks to the development of orally active small molecules that directly target either thrombin or activated factor X. The aim of this article is to highlight the main characteristics of these new classes of anticoagulant drugs, summarize the development program of the most advanced molecules and review the most recent published data on Phase III trials of DVT treatment for both the acute phase and the secondary prevention of the disease. Oral administration, predictable anticoagulant responses, low potential for drug–drug interactions and the positive first published clinical data, render direct thrombin and activated factor X inhibitors good candidates to replace oral vitamin K antagonist and low molecular weight heparins for DVT treatment.