Poništavanje učinaka antikoagulantnih lijekova u pripremi za hitni zahvat

master's thesis

• Title (english): Reversing the effects of anticoagulant drugs in preparation for an emergency procedure
• Author: Lucija Jambrošić
• Mentor: Ivan Gornik (mentor)
• Committee member: Dražen Pulanić (predsjednik povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Committee member: Ivan Gornik (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Emergency Medicine

Abstract

U ovom radu prikazana je fiziologija hemostaze i koagulacijska kaskada koja vodi do stvaranja
fibrinskog ugruška. Kroz prikaz prirodnih mehanizama protiv pretjerane aktivacije tog sustava i
sprječavanja posljedica neprimjereno aktiviranog stvaranja ugrušaka u neoštećenim žilama,
prikazani su i lijekovi koji vrše istu funkciju. Ti lijekovi uključuju antiagregacijske lijekove, koji
smanjuju progresiju plakova u arterijskom sustavu i sprječavaju trombozu na mjestu postavljanja
arterijskih potpornica te antikoagulantne lijekove koji smanjuju stvaranje ugrušaka u venskom
sustavu i time sprječavaju venske tromboembolizme, odnosno duboke venske tromboze i plućne
embolije. Antikoagulantna terapija također se koristi kod pacijenata s mehaničkim srčanim
zaliscima, za sprječavanje sistemske embolije u fibrilaciji atrija, a u zadnje vrijeme i u liječenju
periferne vaskularne bolesti. Dan je prikaz najčešće korištenih lijekova iz svake skupine, s
posebnim naglaskom na direktne (nove) oralne antikoagulantne lijekove koji se dijele na inhibitore
faktora Xa te inhibitore trombina. Detaljno su prikazane metode i lijekovi za poništavanje učinaka
lijekova protiv zgrušavanja krvi, njihove doze, indikacije kada se koriste, dostupne rezultate
istraživanja koja pokazuju superiornost jednog agensa na drugi i prikaz prvih dostupnih specifičnih
antidota za nove antikoagulantne lijekove koji omogućuju da se koagulacijska kaskada odvija
svojim normalnim tijekom i time prevenira krvarenje u točno određenim indikacijama, uz
smanjenje nuspojava direktnim djelovanjem na aktivnu tvar u lijeku kojeg poništavaju.

Abstract (english)

This paper presents the physiology of hemostasis and the coagulation cascade that leads to the formation of a fibrin clot. It highlights the presentation of natural mechanisms against excessive activation of this system and prevention of the consequences of inappropriately activated clot formation in undamaged vessels, as well as the drugs that serve the same function. These drugs include antiplatelet drugs, which reduce the progression of plaques in the arterial system and prevent thrombosis at the site of placement of arterial stents, and anticoagulant drugs that reduce the formation of clots in the venous system and thus prevent venous thromboembolism, such as deep vein thrombosis and pulmonary embolism. Anticoagulant therapy is also used in patients with mechanical heart valves, to prevent systemic embolism in atrial fibrillation, and more recently in the treatment of peripheral vascular disease. The paper presents the most commonly used drugs from each group, with a special emphasis on the direct (new) oral anticoagulant drugs, which are divided into factor Xa inhibitors and thrombin inhibitors. Detailed descriptions are provided of the methods and drugs used to reverse the effects of anticoagulant drugs, their dosages, indications for use, available research results demonstrating the superiority of one agent over another, and the introduction of the first available specific antidotes for the new anticoagulant drugs, which allow the coagulation cascade to proceed normally, thereby preventing bleeding in specific indications and reducing side effects through direct action on the active substance in the drug being reversed.

• Keywords: andeksanet alfa; idarucizumab; novi oralni antikoagulansi; tromboembolija
• Keywords (english): andexanet alfa; idarucizumab; new oral anticoagulants; thromboembolism
• Language: croatian
• URN:NBN: urn:nbn:hr:105:289279
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-07-02 21:28:00