Could you please talk about the present of anticoagulant therapy in clinical practice......
<Internation Circulation>:Looking to the future, how do you foresee the development of anticoagulant therapy in the future?
Suzanne Hughes:I think what we need to look at is what would be the ideal anticoagulant if we had a wish list. First It would be a medication that could be given in a fixed dose; Second it would not be effected by patient unique characteristics (and Warfarin does not meet either of those two characteristics because it has to be constantly adjusted based on the INR level); third, it would have rapid onset and end of activity (unlike Warfarin, for example: if a patient needs emergency surgery there is the added concern of reversing the Warfarin effect which is not easily or quickly done); fourth is a medication that has no interaction with other medications or dietary products containing Vitamin K (which can be problematic with Warfarin if, for example, a patient greatly increases their vegetable intake -- such as over a holiday -- suddenly increasing their Warfarin requirements); fifth, a drug that does not require ongoing monitoring, and sixth a drug that is effective as Warfarin, or more effective, but less bleeding risk. There happens to be two drugs now in development: Rivaroxaban and Dabigatran and each look like they might be promising agents for at least some of the indications for which we now give Warfarin.