Extended options of anticoagulant treatment in thromboembolism

Czech version

Authors: Debora Karetová ¹; Jan Bultas ²
Authors‘ workplace: II. interní klinika kardiologie a angiologie 1. LF UK a VFN, Praha, přednosta prof. MUDr. Aleš Linhart, DrSc., FESC, FCMA ¹; Farmakologický ústav 3. LF UK, Praha, přednosta prof. MUDr. Jan Bultas, CSc. ²
Published in: Vnitř Lék 2014; 60(11): 977-984
Category: Reviews

Overview

Thromboembolic disease (TD) is a relatively common disease with acute risk of death and potential long-term consequences in term of postthrombotic syndrome or chronic pulmonary hypertension. Anticoagulant therapy is the basic therapeutic procedure; thrombolytic therapy and the introduction cava filter are appropriately indicated for individual cases. In past few years, new direct oral anticoagulant drugs (NOAC) have occurred – Xa factor or thrombin inhibitors which have demonstrated the same efficacy and even higher safety in comparison to conventional treatment. In mid 2014, 3 drugs of this group are registered in Czech Republic – rivaroxaban (Xarelto^®), dabigatran (Pradaxa^®) and apixaban (Eliquis^®). These drugs have comparable efficacy and safety but they differ in schedule of dose administration. Rivaroxaban and apixaban can be administered immediately after diagnosis of venous thrombosis or hemodynamically stable pulmonary embolism. LMWH application has to precede few days the administration of dabigatran. Limitation of new drugs is their price. Unavailability of antidotes is temporary because current researches continue to find one for dabigatran and another for both of xabans. Duration of anticoagulant treatment after acute phase depends on the presence of thrombosis risk factors and the individual bleeding risk. Minimal duration of anticoagulant therapy is 3 months, commonly 6–12 months and in high risk patients it is “long term” treatment. Good results of new anticoagulant drugs in trials in term of thromboembolism recurrence prevention may change established habits in TD patients with long term treatment.

Keywords:
anticoagulant therapy – apixaban – dabigatran – deep vein thrombosis – new direct oral anticoagulants – rivaroxaban

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