Which drugs are under investigation for deep venous thrombosis (DVT) prophylaxis prior to orthopedic surgery?

Updated: Jul 25, 2019
  • Author: David A Forsh, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Answer

Current research in anticoagulants involves investigations into drugs that act on various phases of the coagulation cascade. For convenience, the authors can arbitrarily divide the process into three phases: the initiation phase, the propagation phase, and the thrombin activity phase.

Drugs under investigation that act in the initiation phase include tissue factor pathway inhibitors (TFPIs) and nematode anticoagulant peptide (NAPc2). These drugs act through inhibition of the factor VIIa/tissue factor complex.

A number of newer synthetic direct or indirect inhibitors of thrombin or factor Xa are being tested. These have similarities to the currently approved fondaparinux. Phase II dose-finding trials in which the metapentasaccharide idraparinux was administered subcutaneously (SC) once each week to prevent the development of secondary venous thromboembolism (VTE) have been completed. A second class of orally active direct factor Xa inhibitors, which includes razaxaban, is also undergoing clinical phase II trials. [61]


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