Title Direktni oralni antikoagulantni lijekovi u hitnoći Title (english) Direct oral anticoagulants in emergencies Author Eva Kos Mentor Ingrid Prkačin (mentor)Committee member Ivan Gornik (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Ingrid Prkačin (član povjerenstva)Granter University of Zagreb Defense date and country 2017-07-14, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Direktni oralni antikoagulantni lijekovi (DOAK) ili novi oralni antikoagulantni lijekovi (NOAK) su lijekovi koji svoj antikoagulantni učinak ostvaruju izravnom inhibicijom trombina (dabigatran) ili izravnom inhibicijom aktiviranog čimbenika X (rivaroksaban, apiksaban i edoksaban). Primjena DOAK-a znači iskorak u kvaliteti i sigurnosti liječenja, stoga im najnovije smjernice u brojnim indikacijama daju prednost u odnosu na antagoniste vitamina K, koji su dugo bili antikoagulantni lijekovi prvog izbora. Na temelju rezultata velikih randomiziranih ispitivanja koja su uspoređivala učinke pojedinih DOAK-a i varfarina može se zaključiti da su DOAK-i u većini slučajeva superiorni varfarinu u prevenciji moždanog udara i sustavne embolije. Zahvaljujući svojim značajkama, sve se više primjenjuju u kliničkoj praksi te u mnogim slučajevima zamjenjuju druge antikoagulantne lijekove. Jedan od razloga sve veće primjene DOAK-a u liječenju i prevenciji venske tromboembolije te prevenciji moždanog udara i sistemske embolije u bolesnika s fibrilacijom atrija zasigurno je i niži rizik od ozbiljnih krvarenja u usporedbi s primjerice heparinom i varfarinom. Ipak, krvarenje koje se može javiti prilikom njihove primjene, zabrinjavajuća je nuspojava, budući da još uvijek nedostaje adekvatna terapija, odnosno specifični antidot za većinu DOAK-a. Bolesnici liječeni antikoagulantnim lijekovima čine značajan postotak pacijenata u ambulantama hitne službe. Njihovo liječenje vrlo je izazovno, s jedne strane zbog povišenog rizika od krvarenja, a s druge strane zbog povišenog rizika od tromboembolije u slučaju prekida antikoagulantne terapije. To je čest slučaj kod različitih kirurških postupaka koji nisu rijetkost u hitnim stanjima. Zbog još uvijek nedovoljno ispitanih specifičnih metoda za reverziju antikoagulantnog učinka DOAK-a, osim za dabigatran, provođenje invazivnih postupaka često zahtijeva multidisciplinarni pristup te primjenu protokola za specifične situacije. Iako su DOAK-i povezani s manje interakcija s drugim lijekovima u usporedbi s varfarinom i heparinom, kombinacija DOAK-a i mnogih lijekova zahtijeva oprez te u nekim slučajevima i klinički nadzor.
Abstract (english) Direct oral anticoagulant drugs (DOACs) or new oral anticoagulant drugs (NOACs) are medicines that achieve their anticoagulant effect by the direct inhibition of thrombin (dabigatran) or by the direct inhibition of activated factor X (rivaroxaban, apixaban and edoxaban). The use of DOACs means a step forward in the quality and safety of the treatment, and therefore in many indications the latest guidelines give them preference over the vitamin K antagonists, which have been anticoagulants of the first choice for a long time. Based on the results of large randomized studies which compared the effects of certain DOACs and warfarin, it can be concluded that in most cases DOACs are superior to warfarin in stroke and systemic embolism prevention. Thanks to their features, they are increasingly applied in clinical practice and in many cases they replace other anticoagulant drugs. One of the reasons for the increasing use of DOACs in treatment and prevention of venous thromboembolism as well as stroke and systemic embolism prevention in patients with atrial fibrillation is certainly a lower risk of serious bleeding compared to, for example, heparin and warfarin. However, bleeding that may occur during the usage of DOACs is a disconcerting side effect, as there is still a lack of adequate therapy or specific antidote for most of the DOACs. Patients treated with anticoagulant medicines make up a significant percentage of patients in emergency room services. Their treatment is very challenging, on the one hand because of the increased risk of bleeding and, on the other, because of the increased risk of thromboembolism due to the anticoagulant therapy interruption. This is a common case in various surgical procedures that are not unusual in emergency situations. Due to still insufficiently tested specific strategies for the reversal of the anticoagulant effects of DOACs, excluding dabigatran, invasive procedures often require a multidisciplinary approach and the use of protocols for specific situations. Although DOACs are associated with fewer interactions with other drugs compared to warfarin and heparin, the combination of DOACs and many drugs requires caution and, in some cases, clinical monitoring.
Keywords
DOAK-i
krvarenje
hitna stanja
interakcije
Keywords (english)
DOACs
bleeding
emergencies
interactions
Language croatian URN:NBN urn:nbn:hr:105:092801 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2017-10-26 08:17:35
