Nihon rinsho. Japanese journal of clinical medicine
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Anticoagulants are recommended for preventing stroke in patients with non-valvular atrial fibrillation (NVAF). Warfarin has been the most common oral anticoagulant for several decades, but use of warfarin has many limitations. Recently, several novel anticoagulants that can overcome the limitations of warfarin have been developed, and some of them are already used in clinical practice in Japan. In this review, we overview the pharmacological mechanisms and the results of the phase III trial of the novel anticoagulants for preventing stroke in patients with NVAF based on the comparison to warfarin.
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In the past, unfractionated heparin and warfarin have been used as anticoagulants for treatment of venous thromboembolism in Japan. Although it has been effective anticoagulants, these uses are accompanied by several pitfalls, which have led to research and the discovery of new additional groups of anticoagulants: parenteral factor Xa inhibitors, such as fondaparinux, and oral direct factor Xa inhibitors, such as rivaroxaban, apixaban and edoxaban. These new anticoagulants are fast-acting, noninferior to heparin and warfarin in preventing recurrence of venous thromboembolism, and do not require monitoring. These new anticoagulants show promise for improvement of long-term outcome for venous thromboembolism.
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Recently in Japan, venous thromboembolism (VTE) [deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE)] has increased with the Westernization of eating habits and the aging of society. In the West, prophylactic guidelines have been discussed for many years, and, unfortunately, Japan falls far behind the West in this area. We developed Japanese Guidelines for VTE prophylaxis based on the 6th ACCP guidelines in 2004. ⋯ As we expected, it significantly decreased after the guidelines for thromboprophylaxis were issued and the management fee for PTE prophylaxis was covered by health insurance in April 2004. However, mechanical prophylaxis is not sufficient to prevent mortality rates, and advanced prophylaxis by anticoagulants, such as low-molecular-weight heparin/Xa inhibitors along with unfractionated heparin/vitamin K antagonists will be essential. As a result of use of anticoagulants, mortality rates have been significantly decreased recently.