INTRODUCTION: The introduction of novel anticoagulants has had contrasting 
effects on the agents in the pipeline, fueling the development of some and 
sinking the others. The complexity of the coagulation cascade offers interesting 
inhibition choices that might become valid treatment options.
AREAS COVERED: This review will highlight some of the anticoagulants in the 
pipeline. Following the success of the direct thrombin and FXa inhibitors 
already in the market, new agents are being tested. These include AZD0837, 
betrixaban, letaxaban, darexaban, and LY517717. Targeting other components of 
the hemostatic pathway might lead to better safety profiles without influencing 
efficacy. Inhibitors to FVIIa-tissue factor (FVIIa/TF) complex, FIX, FXI, and 
FXII are being assessed. New inspiring inhibitors are antisense oligonucleotides 
(ASOs) and aptamers. These are highly specific agents with readily reversible 
effect and might be engineered to inhibit any coagulation factor. Currently 
tested ASOs and aptamers are inhibitors of FXI, FXII, thrombin, FIXa, and 
platelet GPIV.
EXPERT OPINION: Some of the agents in the pipeline offer valid treatment option 
for long-term therapy, overcoming some of the drawbacks of the novel 
anticoagulants. Research is being driven by an expanding market in the 
anticoagulation field that has been unexploited for a long time.