Suvremeni antikoagulantni lijekovi

master's thesis

• Title (english): Modern anticoagulant therapy
• Author: Lucija Zlopaša
• Mentor: Iveta Merčep (mentor)
• Committee member: Srećko Marušić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Iveta Merčep (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Clinical Pharmacology and Toxicology

Abstract

Homeostaza organizma postiže se održavanjem ravnoteže između sustava koji inhibira koagulaciju i sustava koagulacije krvi. Hemostaza se postiže na razne načine, jedan od najkompleksnijih, ali i najbitnijih je kaskada koagulacije. Antikoagulantni lijekovi su lijekovi koji sprječavaju koagulaciju krvi interferencijom sa određenim faktorima koagulacije. Takva akcija u vidu sprječavanja zgrušavanja krvi, potrebna je u mnogobrojnim tromboembolijskim stanjima čije posljedice mogu biti fatalne. Novi oralni antikoagulantni lijekovi zamijenjuju varfarin u različitim indikacijama. U te lijekove spadaju dabigatran koji je inhibitor trombina, te rivaroxaban, apixaban i edoxaban koji inhibiraju aktivnu formu faktora koagulacije X. Dabigatran je lijek izbora u terapiji venske tromboembolijske bolesti, u prevenciji moždanog udara u pacijenata s fibrilacijom atrija te u ishemijskoj bolesti srca. Činjenica da se novi antikoagulantni lijekovi daju u fiksnim dozama i nema potrebe za monitoriranjem je od izrazite važnosti jer omogućava lakše provođenje terapije i veću kooperativnost pacijenata. Rivaroxaban je lijek koji ima identične indikacije kao i dabigatran s jednom razlikom, a to je da je kontraindiciran u trudnica. Apixaban najmanje ovisi o klirensu, a edoxaban je osim u trudnica, kontraindiciran i u pacijenata koji imaju protetičke srčane zalistke. Svi lijekovi iz ove skupine mogu za neželjenu posljedicu imati krvarenje pa je potrebno biti oprezan prilikom uvođenja pacijenata u neuraksijalnu anesteziju ili prilikom izvođenja lumbalne punkcije u pacijenata koji su na terapiji novim oralnim antikoagulantnim lijekovima. Budući da broj pacijenata koji imaju prolongiran vijek života, s bolestima poput duboke venske tromboze ili fibrilacije atrija, raste; raste i potreba za daljnjim proučavanjem i istraživanjem antikoagulantnih lijekova. Iako je otkriće ovih lijekova učinilo nekoliko ključnih koraka prema otkrivanju ''savršenog'' antikoagulansa, prostora za napretkom i daljnjim učenjem uvijek ima. Nove oralne antikoagulantne lijekove trebamo shvatiti kao preludij u iskonskom otkrivanju lijeka bez mane.

Abstract (english)

Homeostasis of the organism is achieved by maintaining a balance between system that inhibits coagulation and blood coagulation system. Hemostasis is achieved in various ways, one of the most complex but also the most important is the coagulation cascade. Anticoagulant drugs are medicines that prevent blood coagulation by interfering with certain coagulation factors. Such action in preventing blood clotting is required in many thromboembolic conditions whose consequences may be fatal. New oral anticoagulant drugs replace warfarin in different indications. These medicines include dabigatran which is a thrombin inhibitor and rivaroxaban, apixaban, and edoxaban that inhibit the active form of coagulation factor X. Dabigatran is a medicine of choice in the treatment of venous thromboembolic disease, stroke prevention in patients with atrial fibrillation, and in ischemic heart disease. The fact that new anticoagulant drugs are given at fixed doses and there is no need for monitoring is significant because it facilitates therapy and patient co-operation. Rivaroxaban is a medicine that has identical indications as dabigatran with one difference and that is that it is contraindicated in pregnant women. Apixaban is least dependent on clearance, and edoxaban is contraindicated in pregnant women and in patients with prosthetic heart valve. There is a need to be careful when introducing patients into neuraxial anesthesia or performing lumbar puncture in patients who are on therapy with new oral anticoagulant drugs. Whereas the number of patients with prolonged life expectancy, with diseases such as deep venous thrombosis or atrial fibrillation, is increasing; there is the need for further study and research of anticoagulant drugs. Although the discovery of these drugs is the result of several key steps towards discovering the "perfect" anticoagulant, there is always room for progress and further learning. New oral anticoagulant drugs should be understood as a prelude to the primary discovery of a drug without flaw.

• Keywords: hemostaza; koagulacijska kaskada; novi oralni antikoagulantni lijekovi
• Keywords (english): hemostasis; coagulation cascade; new oral anticoagulant drugs
• Language: croatian
• URN:NBN: urn:nbn:hr:105:371348
• 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: 2020-04-28 10:23:13