Oral antithrombotic treatment in 2013 – review of drugs, indications and complications management
Authors:
D. Karetová; J. Bultas
Authors‘ workplace:
II. interní klinika kardiologie a angiologie, 1. LF UK a VFN Praha
Published in:
Geriatrie a Gerontologie 2013, 2, č. 1: 16-23
Category:
Review Article
Overview
In the pharmacotherapy of prevention and treatment of vein thrombosis and in the prophylaxis of thrombembolic events in atrial fibrillation two new groups of oral anticoagulants have been introduced in the last few years. The first group is represented by direct thrombin inhibitor dabigatran (Pradaxa). In the second group of xabans there are two factor Xa inhibitors – rivaroxaban (Xarelto) and apixaban (Eliquis). Besides mentioned possibility of oral intake of these drugs there is another advantage - rapid onset of effect within minutes, sufficiently long half-life to administer one or two dosages in one day and predictable efficacy with low interindividual variability which allows treatment without necessity for monitoring. Especially in geriatric patients it is necessary to check the renal function status (due to the route of elimination of these drugs). Also the supervision of regular intake could be important in regard to their half-lives. Other advantage of these new oral anticoagulants is a relatively low potential for drug and food interactions which could be an important issue in seniors with multiple medication. Common disadvantage in all of them is that we have no specific antidotes for counteraction.
In the main indication – prophylaxis of thrombembolic stroke in patients with atrial fibrillation – all the above mentioned drugs are approved for use. Besides the unnecessity of monitoring the main advantage of them is higher efficiency and safety in comparison with the up to now widely used warfarin. In the second main indication – in the prevention of thrombembolic events after joint replacement – also there are these three molecules registered. In the last indication – the treatment of acute deep vein thrombosis and pulmonary embolism and in secondary prevention of these events there could only rivaroxaban be used. Other new molecules are being examined in ongoing clinical trials: edoxaban, otamixaban or betrixaban.
Key words:
prevention and treatment of thrombembolic disease – atrial fibrillation – dabigatran etexilate – rivaroxaban – apixaban
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Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
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