The risk of bleeding, narrow therapeutic index, and need for routine monitoring make oral anticoagulation with warfarin a less than ideal oral anticoagulant. Intravenous therapies such as heparin are not orally bioavailable and have a narrow therapeutic index and high risk of bleeding. New oral antico agulants currently under investigation may have more ideal characteristics for long-term administration. The mechanism of thrombogenesis, limitations of current therapy, and new investigational oral anticoagulants are discussed.
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