Practical aspects of the oral new anticoagulants

UvodTromboza, kao patološki proces intravaskularnog zgrušavanja krvi u odsustvu krvarenja može se javiti u venskoj ili arterijskoj cirkulaciji. Pojačano neželjeno zgrušavanje krvi može izazvati i emboliju, a takva stanja se zajednički nazivaju tromboembolijska stanja. Tromboza predstavlja jedan od značajnijih uzroka morbiditeta i mortaliteta kod različitih populacija pacijenata. Svake godine oko 795.000 osoba doživi novi ili ponovljeni moždani udar. Godišnje se otkrije više od 200.000 novih slučajeva venskog tromboembolizma; pri čemu 30% ljudi umre u toku 30 dana od postavljanja dijagnoze, a jedna petina doživi iznenadnu smrt usled plućne embolije (1).Antikoagulantni lekovi su delotvorni u prevenciji i lečenju tromboze i tromboembolijskih komplikacija. Više od 50 godina antagonisti vitamina K predstavljali su jedine oralne antikoagulanse u kliničkoj praksi. Iako su

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“…Odobren je u dozi od 10 mg jedanput dnevno tokom 35 dana nakon zamene kuka i tokom 12 dana nakon operacije kolena (28).…”

Section: Prevencija Venskog Tromboembolizma Nakon Elektivne Operacijeunclassified

Direct oral anticoagulant drugs in the prophylaxis and therapy of thromboembolic diseases

Tomić¹,

Novakovic²,

Milojević³

et al. 2017

Medicinski casopis

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“…Rivaroxaban, apixaban, and dabigatran Rivaroxaban and apixaban directly inhibit activated factor X, while dabigatran is a direct thrombin inhibitor [Bauer, 2011;DeLoughery, 2011;Hankey and Eikelboom, 2011;Turun et al 2011]. All three drugs are given orally and have been shown to be effective anticoagulants in various indications such as thrombosis prophylaxis after major surgery, deep vein thrombosis, and atrial fibrillation.…”

Section: The New Oral Direct Factor Xa and Thrombin Inhibitorsmentioning

confidence: 99%

Recent advances in the diagnosis and treatment of heparin-induced thrombocytopenia

Bakchoul

Greinacher

2012

Therapeutic Advances in Hematology

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Heparin-induced thrombocytopenia (HIT) is a drug-mediated, prothrombotic disorder caused by immunization against platelet factor 4 (PF4) after complex formation with heparin or other polyanions. After their binding to PF4/heparin complexes on the platelet surface, HIT antibodies are capable of intravascular platelet activation by cross-linking Fcγ receptor IIA leading to a platelet count decrease and/or thrombosis. Diagnosis of HIT is often difficult. This, and the low specificity of the commercially available immunoassays, leads currently to substantial overdiagnosis of HIT. Timing of onset, the moderate nature of thrombocytopenia, and the common concurrence of thrombosis are very important factors, which help to differentiate HIT from other potential causes of thrombocytopenia. A combination of a clinical pretest scoring system and laboratory investigation is usually necessary to diagnose HIT. Although HIT is considered to be a rare complication of heparin treatment, the very high number of hospital inpatients, and increasingly also hospital outpatients receiving heparin, still result in a considerable number of patients developing HIT. If HIT occurs, potentially devastating complications such as life-threatening thrombosis make it one of the most serious adverse drug reactions. If HIT is strongly suspected, all heparin must be stopped and an alternative nonheparin anticoagulant started at a therapeutic dose to prevent thromboembolic complications. However, the nonheparin alternative anticoagulants bear a considerable bleeding risk, especially if given to patients with thrombocytopenia due to other reasons than HIT. While established drugs for HIT are disappearing from the market (lepirudin, danaparoid), bivalirudin, fondaparinux and potentially the new anticoagulants such as dabigatran, rivaroxaban and apixaban provide new treatment options.

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“…Several newer agents, such as dabigatran (a direct thrombin inhibitor) and rivaroxaban and apixaban (factor Xa inhibitors), are approved for use in some of the same clinical contexts as warfarin. Many other compounds, the majority being Xa inhibitors, are in Phase III trials [59]. The new agents have been lauded for easier administration and control (no monitoring required), significantly fewer drug interactions, and equivalent or lower bleeding rates compared with the VKAs.…”

Section: Five-year Viewmentioning

confidence: 99%