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It is anticipated that, as a result of their more predictable pharmacodynamic and pharmacokinetic profiles, the introduction of these new agents will promote adequate oral anticoagulation of appropriate intensity and duration for the initial and continued treatment of DVT and, ultimately, reduce the risk of PTS. The clinical efficacy of dabigatran etexilate, rivaroxaban and apixaban for the treatment of VTE is described in the following sections. In addition, other recent publications collectively provide a comprehensive review of these new oral agents, their development and their clinical trial programmes in a number of indications. Thrombin catalyzes the conversion of fibrinogen to fibrin and also amplifies its own generation by activating Factors VIII and V, which are key cofactors for prothrombinase and intrinsic tenase (86). In addition, thrombin is a potent platelet agonist by recruiting platelets to the site of vascular injury, and also renders fibrin resistant to lysis by activating Factor XIII (86). Dabigatran is a potent, reversible, competitive, oral, direct thrombin inhibitor that is administered as the prodrug dabigatran etexilate. It has a fast onset of action, a terminal half-life of 14�C17?h and is eliminated primarily (about 80%) by renal excretion (87, 88). In March 2008, dabigatran was approved in the European Union for the prevention of VTE in adult patients who have undergone elective total hip or knee replacement surgery. There are four phase III clinical trials �C RE-COVER (NCT00291330; completed), RE-COVER II (NCT00680186; completed), RE-MEDY (NCT00329238; completed) and RE-SONATE (NCT00558259; completed) �C comparing dabigatran with warfarin for the treatment and secondary prevention of VTE. The results of RE-COVER indicated that dabigatran (150?mg twice daily) was as effective as dose-adjusted warfarin in patients with acute VTE who were initially given parenteral anticoagulation therapy for a median of 9?days. The difference in risk of recurrent symptomatic VTE and related deaths was 0.4% [95% confidence interval (CI) ?0.8 to 1.5; P?