畅销书摘

父母的生活习惯、意识及观念能影响孩子的一生。父母掌握的正确健康知识越多,孩子的健康就越有保证。这个世界上好像每个人都是养育孩子的专家。家长们几乎都有这样一个很头疼的问题,在养育孩子方面到底该听谁的。于是,面对铺天盖地的儿童健康书籍,他们很难分辨出哪些是适合自己孩子健康成长的科学养育办法。美国健康教育专家     

New antitoagulants

In contrast to older anticoagulant agents vitamin K antagonists and heparins, the new ones are directed towards a single target in general. The main characteristics of the new agents are: their site of action in the coagulation cascade and their mechanism of action which is indirect, antithrombin dependent, most often such as Fondaparinux and Idraparinux or direct such as Dabigatran, Rivaroxaban; the specificity of the new molecules, since they must not interact with other enzymes: trypsin, kallikrein, t-PA, etc...; their mode of administration parenteral and/or oral; their pharmacokinetics and their clearance frequently by the kidney (Hirudin, fondaparinux) or through hepatic metabolism (argatroban); tolerance including for all compounds the bleeding risk or an unexpected hepatic intolerance for Ximelagatran; the availability of a specific antidote and the cost of the drug; one compound is registered in France Arixtra Fondaparinux in major orthopedic surgery and in the treatment of venous thromboembolism and in prophylactic treatment in medical patients. However, the main indications of interest for these new drugs is atrial fibrillation. There is a real need in this indication and the number of patients to treat is growing with the longer life expectancy.     

New Anticoagulants

Arterial and venous thrombosis are a major cause of morbidity and mortality. Anticoagulants are a cornerstone of treatment in patients with these disorders. The two most frequently used anticoagulants, heparin and warfarin, have pharmacological and/or biophysical limitations that make them difficult to use in day-to-day clinical practice. Development of new anticoagulants, which were designed to overcome these limitations, has been facilitated by an increased understanding of the coagulation cascade, the advent of molecular modeling and structure-based drug design, and the realization that the treatment of thrombosis and its complications consumes billions of dollars in annual healthcare expenditures. New anticoagulants target various steps in the coagulation pathway. Coagulation is triggered by the factor VIIa/tissue factor complex and propagated by factors Xa and IXa, together with their activated cofactors, factor Va and VIIIa, respectively. Thrombin, the final effector in coagulation, then converts soluble fibrinogen into insoluble fibrin, the major matrix protein of the clot. New anticoagulation drugs that target each of these clotting enzymes have been developed. This review will focus on those drugs in more advanced stages of clinical evaluation. These include inhibitors of initiation of coagulation (tissue factor pathway inhibitor, nematode anticoagulant peptide and active-site blocked factor VIIa), inhibitors of propagation of coagulation (active-site blocked factor IXa, antibodies against factor IX/IXa, fondaparinux sodium, direct factor Xa inhibitors, protein C derivatives and soluble thrombomodulin), and thrombin inhibitors (hirudin, bivalirudin, argatroban and ximelagatran).     

New anticoagulants

The quest to develop new antithrombotic agents has been stimulated by clinical needs and by advances in biotechnology that have made it possible to produce drugs that target specific steps in thrombogenesis. Established anticoagulants such as unfractionated heparin and the coumarins are effective, but have two major limitations: narrow therapeutic windows and highly unpredictable dose-response relationships. Consequently, these drugs often cause complications such as serious bleeding that require close monitoring of their use by laboratory tests to balance safety and effect. These limitations provided the impetus for the development of new anticoagulants that inactivate thrombin, factor Xa, factor IXa or the factor VIIa/tissue factor complex. Similarly, agents that enhance the protein C anticoagulant pathway have also been developed. Of these, direct thrombin inhibitors, soluble thrombomodulin, protein C, and activated protein C have been evaluated clinically for parenteral administration. However, there is enormous interest in the development of safer and more effective oral anticoagulants. In the future, such orally active direct inhibitors of thrombin and factor Xa, if they can be given safely without the need for laboratory monitoring, may replace the coumarins for the long-term treatment of thromboembolic disorders. To achieve these goals, these compounds need high, consistent oral bioavailability.