[Role of the new oral anticoagulants in comparison to vitamin K antagonists in practice].

The standardized and constant fixed-dose rate, no necessity for a close and regular blood monitoring as well as the small number of interactions with other drugs and daily food make therapy with the new oral anticoagulants dabigatran and rivaroxaban and in future presumably apixaban much easier and more feasible than the standard therapy with vitamin K antagonists (VKA). In summary the trials focusing on patients with non-valvular atrial fibrillation show that the new substances are at least non-inferior or even coequal to the well-known VKAs regarding prevention of thromboembolism. In addition the risk of fatal and especially intracranial hemorrhage can be considered even lower. Furthermore, the trials indicate a trend in reduction of death from any cause in treating these patients with the new drugs. There was no inferiority or even superiority in patient-outcome in extended prevention of venous thrombosis and pulmonary embolism after knee or hip arthroplasty when treating patients with the new substances by oral administration versus subcutaneous administration of low molecular weight heparin. Comparable results were demonstrated in the therapy of patients with acute deep vein thrombosis compared with the standard therapy of low molecular weight heparin and VKAs while there was a similar safety profile. Concerning the specific treatment of coronary heart disease and a combined antiplatelet therapy, profound data are still missing. The lack of specific antidotes the as yet limited experience with these substances over a longer period of time and last but not least the emerging costs have inhibited a broad use of these new agents up until now.