Antikoagülasyonda yeni ajanlar

Oral antikoagülasyonda s  k kullan  lan varfarinin terapötik aral  ğ  dard  r. Uzun süre tedavi almak zorunda olan hastalar için takip zorlu ğ u olu şturur. Oral antikoagülan kullan  l  rken amaç hastay kanama ve/veya trombozdan korumak ve etkin antikoagülasyon sa ğ lamakt r. Bu nedenle takip ve kullan  m  kolay olan, ilaç-yemek etkile şimi olmayan yeni moleküller geliş tirilmiştir. Yeni ajanlar faktör Xa ve IIa (thrombin) inhibitörleridir. Ülkemizde halen kullan  lan yeni oral antikoagülanlar dabi- gatran, rivaroxaban, apixaban preparatlar d  r. Venöz tromboembolide primer tedavi ve sekonder korumada, total kalça ve diz artroplastisi sonras  venöz trombo- emboli proflaksisinde, nonvalvüler atrial fibrilasyon sonras  inme ve sistemik emboliyi önlemede endikasyonlar  vard  r. Bu ajanlar ş imdilik temkinli kullan  lmak- tad  r. Halen kanama komplikasyonuna karş  tedavi seçenekleri yoktur. Geliş tirilmekte olan antidotlar kanama komplikasyonlar  n  n önleminde ümit vaat etmektedir. Yeterli veri bulunmayan bu ajanlar halen gebelik döneminde kullan  ma uygun de ğ ildir. Bu derlemede yeni oral antikoagülanlardan bahsedilecektir.

New agents used for anticoagulation

Warfarin which is commonly used for oral anticoagulation has a narrow therapeutic range. It creates difficulties in following for the patients who are taking long-term treatment. When using oral anticoagulants; the aim is to protect the patient from bleeding and/or thrombosis, and to provide effective anticoagulation. Therefore new molecules with easy use and follow-up and free from drug-food interaction are developed. New agents are inhibitors of factor Xa and IIa (thrombin). In our country, the new oral anticoagulant preparations dabigatran, rivaroxaban and apixaban are still in use. Its endications include primary treatment and secondary prevention of venous thromboembolism, prophylaxis of venous thrombo- embolism after total hip and knee arthroplasty and prevention of stroke and systemic embolism after nonvalvular atrial fibrillation. For now these agents are used cautiously. There is still no treatment options against bleeding complications. Antidotes that are being developed are promising for prevention of bleeding complications. These agents still dont have enough data for use during pregnancy. In this study we will discuss the new oral anticoagulants.

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