Yeni oral antikoagülanlar
Oral antikoagülanlar günümüzde birçok hastalığın seyrinde görülebilen tromboembolik olayların engellenmesinde ve tedavisinde çok önemli yeri olan ilaçlardır. Varfarin vitamin k antagonistlerinden en çok bilinen ve kullanılan oral antikoagülanlardır. Varfarin ile yapılan tedavi ve takiplerinde görülen zorluklarından dolayı yeni oral antikoagülanlar olarak bilinen ilaçlar ortaya çıkmıştır. Yeni oral antikogülanlar, koagülasyon kaskatında bazı faktörlerin yapı ve işlevlerini bozarak antikoagülan etki göstermektedirler. Monitorizasyon gerektirmemesi, sabit dozda kullanımı, hasta uyumu ve takip kolaylığı gibi birçok avantajları vardır. Yeni oral antikoagülanlar ile yapılan büyük çalışmaların meta-analizlerine bakıldığında, tromboembolik olaylardan koruma ve tedavisinde varfarinden aşağıda kalmadığı, hatta bazı durumlarda üstün olduğu saptanmıştır. Bu ajanların kullanım kolaylığı ve avantajlarından dolayı emboli ve iskemik olaylardan korunma ve tedavisinde hızlı bir şekilde yer bulmuş ve yaygınlaşmıştır. Bu nedenle bu ilaçların kullanımı, tedavideki yerleri, takipleri, olası yan etkileri ve en önemlisi kanama komplikasyonlarının yönetimi iyi bilinmeli ve uygulanmalıdır.
Anahtar Kelimeler:
Yeni oral antikoagülanlar, varfarin, tromboemboli, iskemi, kanama
New oral anticoagulants
Oral anticoagulants are medications that have an important place in the prevention and treatment of thromboembolic events that can be seen in the course of many diseases today. Warfarin, vitamin K antagonists are the most commonly known and used oral anticoagulants. Drugs known as new oral anticoagulants have emerged due to the difficulties in treatment and follow-up with warfarin. New oral anticoagulants exhibit anticoagulant effects, disrupting the structure and function of some factors in the coagulation cascade. There are many advantages such as monitorisation requirement, constant dose use, patient compliance and ease of follow-up. Meta-analyzes of large studies with new oral anticoagulants have shown that they are non-inferior from warfarin in the prevention and treatment of thromboembolic events, and even superior in some cases. Due to the ease of use and advantages of these new agents, they have been rapidly spreading and taking place in the prevention and treatment of embolism and ischemic events. Therefore, the areas of use of these drugs, the location of treatment, follow-up, possible side effects and most importantly management of bleeding complications should be well known and applied.
Keywords:
New oral anticoagulants, warfarin, thromboembolism, ischemia, bleeding,
___
- Kayaalp SO. Rasyonel tedavi yönünden tıbbi farmakoloji. 1. Cilt: Hacettepe-Taş Kitapçılık Limited Şti.; 2000.
- Uzun S, Arslan F. Warfarin kullanan bireylerin eğitiminde hemşirenin rolü. MN Kardiyoloji 2006; 5: 352-4.
- Poller L, Jacobson A, Deykin D, et al. Managing oral anticoagulant therapy. Chest. 2001; 119: 22S- 38S.
- Kearon C, Hirsh J. Changing indications for warfarin therapy. Poller L, Ludlam CA (eds) Recent Advances in Blood Coagulation New York: Churchill Livingstone 1997: 141-60.
- Weitz JI, Gross PL. New oral anticoagulants: which one should my patient use? ASH Education Program Book 2012; 2012: 536-40.
- Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor Xa inhibitors in development. Clinical Pharmacokinetics 2009; 48: 1-22.
- Hammersley D, Signy M. Navigating the choice of oral anticoagulation therapy for atrial fibrillation in the NOAC era. Therapeutic Advances In Chronic Dis 2017; 8: 165-76.
- Gonsalves WI, Pruthi RK, Patnaik MM, editors. The new oral anticoagulants in clinical practice. Mayo Clinic Proceedings 2013: Elsevier.
- Konkle BA. Direct Oral Anticoagulants: Monitoring Anticoagulant Effect. Hematology/Oncology Clinics 2016; 30: 995-1006.
- Thachil J. The newer direct oral anticoagulants: a practical guide. Clinical Med 2014; 14: 165-75.
- Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New Eng J Med 2009; 361: 1139-51.
- Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Eng J Med 2011; 365: 883-91.
- Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. New Eng J Med 2011; 365: 981-92.
- Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. New Eng J Med 2013; 369: 2093-104.
- Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. The Lancet 2014; 383: 955-62.
- Schulman S. New oral anticoagulant agents–general features and outcomes in subsets of patients. Thrombosis Haemostasis 2014; 112: 575-82.
- Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart J. 2016; 37: 2893-962.
- Desai J, Granger CB, Weitz JI, Aisenberg J. Novel oral anticoagulants in gastroenterology practice. Gastrointestinal Endoscopy 2013; 78: 227-39.
- Pollack CV, Reilly PA, van Ryn J, et al, editors. Idarucizumab for dabigatran reversal: updated results of the re-verse ad study. Circulation; 2016: LIPPINCOTT WILLIAMS & WILKINS TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA.
- Pollack Jr CV, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. New Eng J Med 2015; 373: 511-20.
- Yayın Aralığı: Yılda 6 Sayı
- Başlangıç: 2018
- Yayıncı: MediHealth Academy Yayıncılık