New oral anticoagulants and regional anaesthesia

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New oral anticoagulants and regional anaesthesia H.T. Benzon, M.J. Avram, D. Green, R.O. Bonow British Journal of Anaesthesia Volume 111, Pages i96-i113 (December 2013) DOI: 10.1093/bja/aet401 Copyright © 2013 The Author(s) Terms and Conditions

Fig 1 Sites of action of anticoagulant drugs. Clotting factors are indicated by Roman numerals. Warfarin reduces production of factors VII, IX, X, and prothrombin. Heparin and LMWH inhibit factor Xa and thrombin. Fondaparinux, rivaroxaban, and apixaban are direct factor Xa inhibitors. Dabigatran is a DTI. HMWK, high molecular weight kininogen; LMWH, low molecular weight heparin. British Journal of Anaesthesia 2013 111, i96-i113DOI: (10.1093/bja/aet401) Copyright © 2013 The Author(s) Terms and Conditions

Fig 2 Inhibitors of the platelet P2Y12 receptor. Clopidogrel must undergo two metabolic steps to form active drug, prasugrel requires only one step, and ticagrelor is a direct inhibitor. AC, adenylyl cyclase; cAMP, cyclic adenosine monophosphate; PKA, protein kinase A; VASP, vasodilator-stimulated phosphoprotein (-p=phosphorylated). Modified from Capodanno and colleagues,122 with permission from John Wiley and Sons. British Journal of Anaesthesia 2013 111, i96-i113DOI: (10.1093/bja/aet401) Copyright © 2013 The Author(s) Terms and Conditions