Warfarin, heparin and their derivatives have been the traditional anticoagulants 
used for prophylaxis and treatment of venous thromboembolism. While the modern 
clinician is familiar with the efficacy and pharmacokinetics of these agents, 
their adverse effects have provided the impetus for the development of newer 
anticoagulants with improved safety, ease of administration, more predictable 
pharmacodynamics and comparable efficacy. Research into haemostasis and the 
coagulation cascade has made the development of these newer anticoagulants 
possible. These drugs include the factor Xa inhibitors and IIa (thrombin) 
inhibitors. Direct and indirect factor Xa inhibitors are being developed with a 
relative rapid onset of action and stable pharmacokinetic profiles negating the 
need for close monitoring; this potentially makes them a more attractive option 
than heparin or warfarin. Examples of direct factor Xa inhibitors include 
apixaban, rivaroxaban, otamixaban, betrixaban and edoxaban. Examples of indirect 
factor Xa inhibitors include fondaparinux, idraparinux and idrabiotaparinux. 
Direct thrombin inhibitors (factor IIa inhibitors) were developed with the 
limitations of standard heparin and warfarin in mind. Examples include 
recombinant hirudin (lepirudin), bivalirudin, ximelagatran, argatroban, and 
dabigatran etexilate. This review will discuss emerging novel anticoagulants and 
their use for the prophylaxis and management of venous thromboembolism, for 
stroke prevention in nonvalvular atrial fibrillation and for coronary artery 
disease.