Primjena novih oralnih antikoagulansa u terapiji tromboze ventrikula

master's thesis

• Title (english): Use of new oral anticoagulants in the treatment of left ventricular thrombus
• Author: Petra Potrebica
• Mentor: Matias Trbušić (mentor)
• Committee member: Nikola Bulj (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Matias Trbušić (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

Tromboza ventrikula (LVT) javlja se kao komplikacija infarkta miokarda, osobito onih anteriorne i apikalne lokalizacije, kao i nekih ne-ishemičkih kardiomiopatija. Sa sobom nosi rizik od moždanog udara (MU) te sistemskih embolija (SE). Rizik nastanka ventrikulskog tromba i njegovih komplikacija mogu smanjiti uspješno liječenje podležećeg stanja te kvalitetna i pravovremena slikovna dijagnostika, no osnovu zbrinjavanja tromboze ventrikula čini antikoagulantna terapija. Prema aktualnim smjernicama, antikoagulansi izbora u terapiji tromboze ventrikula su antagonisti vitamina K (VKA), na čelu s varfarinom. Međutim, uzak terapijski raspon varfarina i brojne interakcije s hranom i drugim lijekovima često dovode do suboptimalnog antikoagulantnog djelovanja i pojave krvarenja ili tromboze, dok potreba za učestalim laboratorijskim testovima dovodi do smanjene suradljivosti pacijenata. S druge strane, novi oralni antikoagulansi (NOAK) primjenjuju se u fiksnim dozama i ne zahtijevaju redovite provjere stanja koagulacije, te stupaju u znatno manje interakcija od varfarina. Zahvaljujući svojem relativno stabilnom antikoagulantnom djelovanju i kraćem poluvijeku života krvarenja su rjeđa i blaža nego pri korištenju varfarina. Iz navedenih razloga, novi oralni antikoagulansi postaju sve atraktivnija alternativa varfarinu u brojnim indikacijama, od fibrilacije atrija do venske tromboembolije. Međutim, njihovo korištenje u terapiji tromboze ventrikula i dalje je nedovoljno istraženo područje te je većinom opisano kroz prikaze slučajeva ili retrospektivne studije. Nekoliko dosad provedenih i objavljenih prospektivnih randomiziranih istraživanja uspoređivalo je njihovo djelovanje u usporedbi s varfarinom te pokazuju obećavajuće rezultate, no potrebna su veća istraživanja ovog tipa kako bi se u potpunosti utvrdila učinkovitost i sigurnost NOAK-a i za ovu indikaciju.

Abstract (english)

Left ventricular thrombosis (LVT) occurs as a complication of myocardial infarction (MI), especially of anterior and apical MI, and of some non-ischemic cardiomyopathies. It increases the risk of stroke and systemic embolisms. The risk of formation of a ventricular thrombus and complications caused by it can be reduced by successful treatment of the underlying condition, and high-quality and timely imaging. However, the basic treatment for ventricular thrombosis consists of anticoagulant therapy. According to the current guidelines, the anticoagulant medicines of choice for the treatment of ventricular thrombosis are vitamin K antagonists (VKA), primarily warfarin. Yet, the narrow therapeutic range of warfarin and its numerous interactions with food and other medicines, often result in suboptimal anticoagulant effect and occurrence of bleeding or thrombosis, while the necessity of frequent laboratory examinations leads to a decrease in patient compliance. On the other hand, new oral anticoagulants (NOAC) are administered in fixed doses, they do not require regular coagulation controls and they interact with significantly lower number of medicines than warfarin. Due to their relatively stable anticoagulatory effect and shorter half-life, bleeding occurs more rarely and is lighter than when caused by warfarin. The above-mentioned reasons have made new oral anticoagulants an ever more attractive alternative to warfarin for a number of indications, from atrial fibrillation to venous thromboembolism. Nonetheless, their use in the treatment of ventricular thrombosis has not been researched sufficiently; it has been described mainly through case studies and retrospective studies. Several prospective randomized trials conducted and published to date have compared the effectiveness of NOACs to that of warfarin and the results have been promising. Still, broader research of this type is needed to fully establish the effectiveness and safety of NOACs when administered for this indication.

• Keywords: tromboza ventrikula; antikoagulantna terapija; novi oralni antikolagulansi
• Keywords (english): left ventricular thrombosis; anticoagulant therapy; new oral anticoagulants
• Language: croatian
• URN:NBN: urn:nbn:hr:105:189441
• 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: 2023-10-30 10:13:56