Suvremena antikoagulantna terapija

master's thesis

• Title (english): Contemporary anticoagulant therapy
• Author: Danijel Čolak
• Mentor: Dražen Pulanić (mentor)
• Committee member: Robert Likić (predsjednik povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Committee member: Dražen Pulanić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Hemostaza je fiziološki proces zaustavljanja krvarenja. U slučaju prokoagulantno narušene hemostatske ravnoteže nastaje tromboza. Antikoagulantni lijekovi omogućuju prevenciju i liječenje tromboembolijskih incidenata inhibirajući faktore zgrušavanja. Važno je prepoznati klinička stanja u kojima je potrebno uvesti profilaksu ili započeti liječenje. Najvažnije indikacije za uvođenje antikoagulantnih lijekova su venske i arterijske tromboembolije, bolesti srčanih zalistaka, postojanje umjetnih srčanih zalistaka, atrijska fibrilacija, infarkt miokarda, perioperativna i postoperativna profilaksa, te profilaksa u drugih protrombogenih bolesti i stanja. Prema načinu primjene, antikoagulanse dijelimo na parenteralne i oralne. U skupinu parenteralnih antikoagulantnih lijekova ubrajamo nefrakcionirani heparin, niskomolekularni heparin, fondaparinuks i argatroban.

U skupinu oralnih antikoagulantnih lijekova ubrajamo antagoniste vitamina K i direktne oralne antikoagulantne lijekove (DOAK). Najčešći predstavnik antagonista vitamina K je varfarin. Direktni oralni antikoagulantni lijekovi uzrokuju inhibiciju trombina – dabigatran, ili faktora Xa – rivaroksaban, apiksaban, edoksaban. U ovom radu prikazujemo obilježja parenteralnih i oralnih antikoagulantnih lijekova koji su danas dostupni u suvremenom kliničkom radu, njihovu farmakodinamiku, farmakokinetiku, doziranje, kliničke indikacije i kontraindikacije te nuspojave.

Abstract (english)

Hemostasis is the physiological process that stops bleeding. In the case of a procoagulantly disrupted hemostatic balance, thrombosis occurs. Anticoagulant drugs enable the prevention and treatment of thromboembolic incidents by inhibiting clotting factors. It is important to recognize conditions in which prophylaxis or treatment is necessary. The most important indications for introducing anticoagulant therapy are arterial and venous thromboembolism, heart valve diseases, the presence of artificial valves, atrial fibrillation, myocardial infarction, perioperative and postoperative prophylaxis and prophylaxis in other prothrombogenic diseases and conditions. Depending on o the route of administration, anticoagulants are divided into parenteral and oral. Parenteral anticoagulant drugs include unfractionated heparin, low molecular weight heparin, fondaparinux and argatroban.

Oral anticoagulant drugs are categorized into vitamin K antagonists and direct oral anticoagulants (DOACs). The most common representative of vitamin K antagonists is warfarin. Direct oral anticoagulant drugs cause thrombin inhibition (dabigatran) or factor Xa inhibition (rivaroxaban, apixaban, edoxaban). This thesis presents the characteristics of parenteral and oral anticoagulant drugs that are currently available in modern clinical practice, their pharmacodynamics, pharmacokinetics, dosages, clinical indications and contraindications, and side effects.

• Keywords: tromboza; antikoagulantna terapija; heparin; varfarin; DOAK
• Keywords (english): thrombosis; anticoagulant therapy; heparin; warfarin; DOAC
• Language: croatian
• URN:NBN: urn:nbn:hr:105:392293
• 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: 2023-10-23 12:55:48