Mesto direktnih oralnih antikoagulansa u prevenciji/lečenju venskog tromboembolizma
Sažetak
Venski tromboembolizam (VTE; uključuje duboku vensku trombozu, DVT i plućnu emboliju, PE) predstavlja treći najčešći akutni kardiovaskularni sindrom. Savremeno zbrinjavanje VTE uključuje primarnu prevenciju kod visokorizičnih pacijenata, lečenje uspostavljene VTE i prevenciju relapsa (sekundarna prevencija). Antikoagulansi su osnova farmakološke profilakse i lečenja VTE. Tokom nekoliko decenija su parenteralni (heparin i niskomolekularni heparini, LMWH) i oralni antikoagulansi (antagonisti vitamina K, VKA) bili kamen temeljac prevencije/lečenja VTE. Uvođenje direktnih oralnih antikoagulansa (DOAK: inhibitor trombina dabigatran i inhibitori Xa rivaroksaban, apiksaban, edoksaban i betriksaban) značajno je poboljšalo prevenciju i lečenje VTE prevazilaženjem mnogih nedostataka konvencionalnih antikoagulansa. Za primarnu prevenciju VTE kod pacijenata nakon totalne artroplastike kuka/kolena, rivaroksaban, apiksaban i dabigatran su u prednosti nad LMWH, zbog uporedive efikasnosti i bezbednosti, ali i bolje prihvatljivosti za pacijenta (izbegavanja svakodnevnih injekcija). U ostalim populacijama visokog rizika (drugi hirurški pacijenti, pacijenti sa različitim akutnim oboljenjima), LMWH su i dalje preporučena profilaksa. Betriksaban je trenutno jedini DOAK odobren za profilaksu VTE kod akutno bolesnih pacijenata tokom i nakon hospitalizacije. Za akutni tretman VTE i sekundarnu prevenciju, DOAK (rivaroksaban, apiksaban, edoksaban i dabigatran) se preporučuju kao prva linija terapije u opštoj populaciji. DOAK su se pokazali slično efikasni, ali bezbedniji od VKA. U nekim specifičnim populacijama pacijenata DOAK takođe imaju prednost u odnosu na konvencionalnu antikoagulantnu terapiju (pacijenti sa oštećenjem bubrega, starije osobe, dugotrajna sekundarna prevencija kod kancerskih pacijenata). Trenutno ne postoje podaci iz studija direktnog poređenja između klasa ili predstavnika DOAK-a, tako da se izbor uglavnom vrši prema karakteristikama pacijenta i farmakokinetičkim osobinama leka.
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