Oral Xa inhibitors in specific situations Review article
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Abstract
Prevention and management of thromboembolic disease with oral anticoagulants is one of the most common clinical situations encountered in patient care. Until now, agents acting as vitamin K antagonists were among the most frequently chosen options for anticoagulation. However, their efficacy and safety of use is hindered by their narrow therapeutic range, multiple drug interactions, inter-individual variability in drug metabolism and diet. The variety of anticoagulation options has been steadily expanding over the past few decades, including the development of novel oral anticoagulants, which their exert action by direct inhibition of thrombin and factor Xa’s block major procoagulant activities and significantly reduce the risk of venous thromboembolic disease, while they cause minimal side effects when compared to vitamin K antagonists. Moreover, they are generally given at a fixed dose, do not require routine monitoring of coagulation and are bioavailable upon oral administration. Several oral agents are available, including rivaroxaban – a direct factor Xa inhibitor, effective in prophylaxis of venous thrombosis in various clinical settings. The development of novel oral anticoagulants has significantly altered clinical practice, and their appropriate use requires knowledge of their individual characteristics, which are different when compared to vitamin K antagonists. This article discusses current knowledge and guidelines of clinical use of novel oral anticoagulants in most common clinical
settings.
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