Direktni oralni antikoagulantni lekovi i njihovi antidoti u profilaksi i terapiji tromboembolijskih bolesti
Sažetak
Više od 50 godina, antagonisti vitamina K su bili jedini dostupni oralni antikoagulantni lekovi. S obzirom da njihova primena podrazumeva brojna ograničenja, bilo je neophodno razviti i uvesti u kliničku praksu nove oralne antikoagulantne lekove. Ovi lekovi imaju brojne prednosti u odnosu na antagoniste vitamina K, koje uključuju brz početak i prestanak dejstva, mali broj interakcija sa drugim lekovima i hranom, pojednostavljen način doziranja, kao i predvidivu farmakokinetiku, čime se eliminiše potreba za svakodnevnim laboratorijskim praćenjem. Pored toga, novi oralni antikoagulantni lekovi deluju selektivno samo na jedan faktor koagulacije. Trenutno su odobreni za upotrebu direktni inhibitor trombina, dabigatran eteksilat, kao i direktni inhibitori faktora Xa, rivaroksaban, edoksaban i apiksaban. Dabigatran eteksilat i apiksaban su odobreni za primarnu prevenciju venske tromboembolije kod odraslih pacijenata koji se podvrgavaju elektivnom hirurškom zahvatu totalne zamene kuka ili kolena, dok je za prevenciju moždanog udara i sistemske embolije kod odraslih pacijenata sa nevalvularnom atrijalnom fibrilacijom, pored navedenih antikoagulantnih lekova, odobren i edoksaban. Za terapiju i prevenciju rekurentne duboke venske tromboze odobreni su dabigatran eteksilat, rivaroksaban i edoksaban. Treba pomenuti da je rivaroksaban odobren i za sekundarnu prevenciju aterotrombotičkih događaja nakon akutnog koronarnog sindroma.
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