Nature Medicine | Spoonful of Medicine

VIDEO: The war is on to replace warfarin

Earlier this month, the European Medicines Agency approved Boehringer Ingelheim’s blood-thinner drug Pradaxa (dabigatran) as a stroke prevention treatment in people with a cardiac arrhythmia condition known as atrial fibrillation. The clot-prevention agent, which gained US approval last October, is the first replacement to the anticoagulation standby warfarin to be green-lighted for this disease in 50 years — but it’s probably not the last.

Next month, a panel of experts convened by the US Food and Drug Administration will consider whether Bayer and Johnson & Johnson’s Xarelto (rivaroxaban), currently approved in the EU, US and Canada to prevent blood clots in people having hip and knee replacement surgeries, should be used to treat atrial fibrillation. And later this month, Bristol-Myers Squibb and Pfizer will present data at the European Society of Cardiology meeting in Paris showing that their Eliquis (apixaban) — currently also approved in the EU for post-surgery treatment — is better and safer than warfarin for the same indication.

With annual sales of stroke prevention drugs expected to reach $14 billion by 2017, these new medicines could become big earners. Here, Nature Reviews Drug Discovery presents a video outlining the half-century quest to bring these agents to market.

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