Duboka venska tromboza kod bolesnika s kroničnom bubrežnom bolesti i direktni oralni antikoagulantni lijekovi

master's thesis

• Title (english): Deep venous thrombosis in patients with chronic kidney disease and direct oral anticoagulants
• Author: Matea Kovačić
• 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; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Basic Medical Sciences; Pharmacology

Abstract

Duboka venska tromboza je multifaktorijalna i česta bolest, pogotovo kod starijih ljudi. Prepoznati su brojni čimbenici rizika za njen nastanak. Pacijenti s kroničnom bubrežnom bolesti predstavljaju specifičnu skupinu. Oni su visokorizična skupina za trombozu, kako u venskoj, tako i u arterijskoj cirkulaciji. Osim toga, zbog poremećaja u građi membrane trombocita imaju povećan rizik od krvarenja. Direktni oralni antikoagulantni lijekovi (DOAK) su odobreni u liječenju više tromboembolijskih stanja i imaju prednosti pred tradicionalnom terapijom. Postali su lijekovi prvog izbora za liječenje venske tromboembolije. Četiri DOAK-a, uključujući tri inhibitora faktora Xa (rivaroksaban, apiksaban i edoksaban) i jedan inhibitor trombina (dabigatran), predstavljaju terapijsku alternativu antagonistima vitamina K. U usporedbi s varfarinom, DOAK-i imaju širi terapijski raspon, ne zahtijevaju rutinsko laboratorijsko praćenje učinka i ne ulaze u interakcije s hranom. Nažalost, postoji vrlo malo podataka o upotrebi DOAK-a kod pacijenata s teško oštećenom bubrežnom funkcijom. Svaki se DOAK dijelom izlučuje bubrezima. Iz tog razloga pacijentima treba periodično procjenjivati bubrežnu funkciju kako bi se utvrdilo je li lijek kontraindiciran i kako bi se, što je rijetko potrebno, prilagodila doza.

Abstract (english)

Deep venous thrombosis is a multifactorial and common disease, especially in the elderly. A number of risk factors for thrombosis have been identified. Patients with chronic kidney disease represent a special group. They represent a high-risk group for thrombosis both in the cardiovascular territory and also in the venous circulation. On the other hand, abnormalities in the platelet membranes put them at higher risk of bleeding. Direct oral anticoagulants (DOAC) are approved for multiple thromboembolic disorders and provide advantages over existing agents. They have now become the first-line choice for treatment of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran), provide oral anticoagulation therapy alternatives to vitamin K antagonist therapy. Compared with warfarin, the DOACs have a wider therapeutic index, not requiring routine laboratory monitoring or dietary restrictions. Unfortunately, extremely limited data exist for the use of DOACs in patients with severe renal insufficiency. Each of the DOACs is, at least in part, cleared by the kidneys. For that reason, the patients require periodic assessment of renal function to determine when dose adjustments are necessary or if their use is contraindicated.

• Keywords: duboka venska tromboza; kronična bubrežna bolest; direktni oralni antikoagulantni lijek
• Keywords (english): deep venous thrombosis; chronic kidney disease; direct oral anticoagulant
• Language: croatian
• URN:NBN: urn:nbn:hr:105:641928
• 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: 2018-04-03 11:32:41