Praktični aspekti u određivanju antikoagulantnog dejstva direktnih oralnih antikoagulantnih lekova
Sažetak
Nova generacija oralnih antikoagulantnih lekova omogućava direktnu inhibiciju FIIa ili FXa, i sve više zamenjuje klasične antikoagulanse u kliničkoj praksi za različita stanja. Ovi lekovi su označeni sa nekoliko akronima, uključujući NOAC, DOAC, i odnose se na nove (ne-vitamin K antagoniste) i direktne oralne antikoagulanse, a trenutno uključuju dabigatran (FIIa inhibitor), i rivaroksaban, apiksaban i edoksaban (FXa inhibitori) . Direktni oralni antikoagulantni lekovi odobreni su za prevenciju moždanog udara kod pacijenata sa ne-valvularnom atrijalnom fibrilacijom i za prevenciju i lečenje venskog tromboembolizma. „Mantra” da direktni oralni antikoagulantni lekovi ne zahtevaju laboratorijsko praćenje ne može se prihvatiti u mnogim kliničkim situacijama. Štaviše, pošto ovi lekovi „ne zahtevaju” laboratorijsko praćenje, neki kliničari su to prihvatili kao da ne utiču na testove u hemostazi. Postoji više situacija u kojima je potrebno rutinsko i hitno određivanje DOAC-a, pri čemu će se broj laboratorijskih zahteva povećavati u budućnosti jer sve više zamenjuju konvencionalne antikoagulanse za sve veći broj indikacija, kod sve većeg broja pacijenata. Glavni cilj ovog rada je da odgovori na praktična pitanja u opštem laboratorijskom ispitivanju DOAC-a, kao i da pomogne u uklanjanju i smanjenju dijagnostičkih grešaka povezanih sa ispitivanjem hemostaze. Testovi za kvantifikaciju DOAC-a moraju biti dostupni u medicinskim centrima 24 sata, kako bi se olakšalo optimalno lečenje u uslovima kada stvari pođu po zlu ili u hitnim slučajevima trenutnog ukidanja antikoagulantne terapije ili odgovarajuće primene specifičnog antidota.
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