The rapid onset/offset effect greatly reduces the need for “bridging” with parenteral anticoagulants after surgeries.
Other Xa inhibitors advantages are rapid onset/offset, few drug interactions and predictable pharmacokinetics. Direct Xa inhibitors are just as efficacious as LMWH and warfarin but they are given orally and don't need as strict monitoring. In 2008 the first direct Xa inhibitor was approved for clinical use. For a modern society, convenient and fast drug administration is the key to a good drug compliance. Because of these disadvantages there has been an urgent need for better anticoagulant drugs. Currently, the main problem with low molecular weight heparin (LMWH) is the administration route, as it has to be given subcutaneously. If supervision isn't adequate warfarin poses a threat in causing, all too frequent, haemorrhagic events and multiple interactions with food and other drugs. Warfarin treatment requires blood monitoring and dose adjustments regularly due to its narrow therapeutic window. It wasn't until 1954 that it was approved for medicinal use in humans making warfarin the first oral anticoagulant drug. He and his colleagues worked on several variations and ended up with a substance they named warfarin in 1948. They patented the right for the substance and in 1945 Link started selling a coumarin derivative as a rodenticide. It took them 6 years to discover dicoumarol, the causing agent. Link and his student Wilhelm Schoeffel started an intense investigation to find the substance causing the internal bleeding. It wasn't until ten years after the outbreak, that a local investigator, Karl P. The disease was named sweet clover disease because the cattle had grazed on sweet clover hay.
In the 1920s there was an outbreak of a mysterious haemorrhagic cattle disease in Canada and the northern United States.
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