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New anticoagulant gets mixed results

BMJ 2007; 335 doi: (Published 20 September 2007) Cite this as: BMJ 2007;335:586

Idraparinux is a new anticoagulant that inhibits activated factor X. It has a long half life and can be given just once a week, by subcutaneous injection. But is it as good as standard anticoagulants at preventing recurrent venous thromboembolism?

In two parallel trials, the new drug worked well for patients with deep vein thrombosis but not so well for those with a pulmonary embolus.

Both trials compared idraparinux with the usual regimen of intravenous heparin followed by warfarin for three to six months. Among 2904 patients with deep vein thrombosis, risk of a recurrence was about the same in both groups (odds ratio 0.98 for idraparinux, 95% CI 0.63 to 1.50 at three months), but idraparinux caused fewer clinically relevant bleeding complications. Among 2215 patients with pulmonary embolus, idraparinux was associated with a significantly higher rate of recurrence at both three and six months (2.14; 1.21 to 3.78 at three months). It was also associated with a significant excess of deaths (6.4% v 4.4% at six months, P=0.04), including deaths from pulmonary embolus.

Bleeding was less of a problem for patients taking idraparinux in both trials. But the authors warn that the new agent has a very long half life, and there's no antidote when bleeding does occur.


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