Direktni oralni antikoagulansi – novo poglavlje u antikoagulantnoj terapiji
Sažetak
Tromboembolijski događaji predstavljaju vodeći uzrok morbiditeta i mortaliteta širom sveta. Od druge polovine 20. veka, antagonisti vitamina K (VKA), varfarin i acenokumarol bili su jedini dostupni oralni antikoagulantni lekovi. Pojava direktnih oralnih antikoagulanasa (DOAK), od pre 10-tak godina, donela je veliku promenu u antikoagulantnoj terapiji. Direktni inhibitor trombina (dabigatran) i direktni inhibitori faktora Xa (rivaroksaban, apiksaban, edoksaban i betriksaban) su pokazali povoljan odnos koristi i rizika. U poređenju sa varfarinom, DOAK pokazuju predvidljiv farmakokinetički profil, nižu incidencu ozbiljnog krvarenja posebno intrakranijalnog krvarenja i stupaju u mali broj interakcija sa drugim lekovima. Pored toga, DOAK imaju brz nastup dejstva i pokazali su komparabilnu efikasnost u poređenju sa varfarinom i niskomolekularnim heparinima (LMWH) u kliničkim ispitivanjima. Posledično, DOAK postepeno zamenjuju VKA i LMWH u mnogim indikacijama uključujući prevenciju moždanog udara i sistemskog embolizma kod pacijenata sa nevalvularnom atrijalnom fibrilacijom, prevenciju i terapiju venskog tromboembolizma, kao i tromboprofilaksu nakon ugradnje veštačkog kolena/kuka. Dodatno, rivaroksaban (sa aspirinom ili kombinacijom aspirina i klopidogrela) je indikovan u prevenciji aterotrombotičnih događaja posle akutnog koronarnog sindroma, kod pacijenata sa povećanim srčanim biomarkerima. U slučaju pojave ozbiljnog krvarenja, dostupni su antidoti; idarucizumab za dabigatran i andeksanet alfa za rivaroksaban i apiksaban.
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