KRVARENJE UDRUŽENO SA PRIMENOM DIREKTNIH ORALNIH ANTIKOAGULANSA
Sažetak
Ključ lečenja i prevencije venskog tromboembolizma (VTE) predstavlja primena antikoagulantne terapije. Dugi niz godina, kamen temeljac je predstavljala primena antagonista vitamina K (VKA) koja je bila povezana sa mnogobrojnim preprekama i komplikacijama. Uvođenjem nove generacije direktnih oralnih antikoagulantnih lekova (DOAK) neke od prepreka, kao što su brzina postizanja terapijskog efekta, fiksna doza, inhibicija manjeg broja koagulacionih faktora, manji broj interakcija sa lekovima su prevaziđene, uz zadržavanje adekvatnog bezbedonosnog profila. Stoga su se DOAK vrlo brzo našli u preporukama za lečenje i prevenciju VTE, kao i za prevenciju ishemijskih komplikacija kod pacijenata sa atrijalnom fibrilacijom bez mehaničke valvule. Ipak, primenom antikoagulantne terapije, narušava se homeostaza, te lečenjem ili sprečavanjem VTE sa jedne strane, povećavamo rizik od krvarenja sa druge. Brojne studije, kako randomizovane kliničke, tako i retrospektivne su analizirale rizik od krvarenja nakon primene DOAK u poređenju sa VKA, kao i između DOAK međusobno. Nedvosmisleno je pokazano da je rizik od intrakranijalne hemoragije manji sa DOAK u poređenju sa VKA, dok je većina studija pokazala da je i rizik od major krvarenja isti ili čak i manji sa DOAK. Upravo veća bezbednost, efikasnost, kao i jednostavna primena DOAK su dovela do toga da se sve češće primenjuju u svakodnevnoj kliničkoj praksi, te se čini da će VKA postepeno postati deo istorije, odnosno da će se koristiti samo u određenoj, jasno definisanoj populaciji.
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