Ximelagatran (Exanta): alternative to warfarin?

Christy Vaughan, PharmD

For decades, the standards of antithrombotic therapy have been heparin and coumarin compounds, primarily warfarin. Other newer approaches include low-molecular-weight heparins, fondaparinux, lepirudin, argatroban, and melagatran (investigational). Although existing treatments are effective, they have many limitations. A safer, more convenient therapy is needed. Ximelagatran is the first oral treatment in a new World Health Organization class of direct thrombin inhibitors and is the first new oral anticoagulant since the introduction of warfarin almost 60 years ago. It was submitted to the Food and Drug Administration for approval in December 2003.