Novi antikoagulantni lijekovi

master's thesis

• Title (english): New anticoagulant drugs
• Author: Ana Marija Slišković
• Mentor: Iveta Šimić (mentor)
• Committee member: Silva Zupančić-Šalek (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Iveta Šimić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Novi oralni antikoagulansi učinkovita su mjera prevencije i liječenja tromboembolijskih bolesti za koje se vezuje visok morbiditet i mortalitet. Mehanizam njihovog djelovanja temeljen je bilo na inhibiciji trombina ili inhibiciji aktivnog faktora X. Lijekovi su visoke učinkovitosti, povoljnih farmakokinetičkih svojstava, s manjom incidencijom zabilježenih nuspojava u odnosu na alternativnu antikoagulaciju varfarinom.
Nuspojave se javljaju kao rezultat djelovanja lijeka na zgrušavanje krvi i mogu biti od rijetkih i životno ugrožavajućih do blažih i čestih krvarenja. Od direktnih inhibitora trombina značajan je dabigatran, a u inhibitore faktora Xa ubrajamo apiksaban i rivaroksaban. ----- Za razliku od vitamina K koji možemo primijeniti kao antidot u slučaju predoziranja varfarinom, specifične molekule koje poništavaju učinak NOAC-a još su u fazi razvoja ili su nedavno odobrene pa zbog toga nisu dostupne u svakodnevnom radu.
Mjere opreza potrebne su kod bubrežnih bolesnika, starijih bolesnika, onih sa umjetnim zaliscima, prirođenim koagulopatijama ili bilo kojim drugim stanjima koje povećavaju rizik krvarenja.
Prije propisivanja NOAC-a, liječnik bi se trebao upoznati s postojećim komorbiditetima i ostalom terapijom koju pacijent konzumira jer to može imati utjecaja na učinkovitost NOAC-a.
Uz adekvatno korištenje te edukaciju bolesnika i članova obitelji o pravilnom doziranju i važnosti strogog pridržavanja antikoagulantne terapije, NOAC-i su lijekovi sigurnog profila.

Abstract (english)

New oral anticoagulants are effective measures of prevention and treatment of thromboembolic disease that is associated with both: high morbidity and mortality. Their mechanism of action is based on the inhibition of thrombin, or active factor X. These drugs have high efficiency, favorable pharmacokinetic parameters, with lower incidence of reported side effects compared to alternative anticoagulation with warfarin.
Side effects can occur due to action of the drug on blood clotting and may vary from rare and life-threatening to mild and frequent bleeding. Dabigatran is an important direct thrombin inhibitor, while in factor Xa inhibitors we include rivaroxaban and apixaban. ----- Unlike vitamin K, which can be used as an antidote for an overdose of warfarin, specific molecules that can reversed the effect of NOAC are still explored or have been recently approved and therefore they are not available in daily clinical practice. Precautions are needed in patients with kidney failure, the elderly, those with artificial heart valves, congenital coagulopathy or any other conditions that increase the risk of bleeding. Before prescribing NOAC, a physician should be familiar with the existing co-morbidities and other consumed therapy because it can affect the performance of NOAC's. With appropriate use and education of patients and family members about the proper dosage and the importance of strict adherence to anticoagulation therapy, NOAC ̓s are medicines with safe profile.

• Keywords: NOAC; antikoagulacija; tromboembolija; krvarenje; antidot
• Keywords (english): NOAC; anticoagulation; thromboembolism; bleeding; antidote
• Language: croatian
• URN:NBN: urn:nbn:hr:105:610436
• 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: 2017-07-05 12:01:41