Oral thrombin inhibitors in specific situations Review article

Article Sidebar

Requires Subscription PDF (Język Polski)


Published: Sep 30, 2014
Keywords:
NOAC, dabigatran, thromboembolism, anticoagulation therapy

Main Article Content

Łukasz Milanowski
Centrum Badań Przedklinicznych i Technologii (CePT), Katedra i Zakład Farmakologii Doświadczalnej i Klinicznej, Warszawski Uniwersytet Medyczny
Marek Postuła
1. Centrum Badań Przedklinicznych i Technologii (CePT), Katedra i Zakład Farmakologii Doświadczalnej i Klinicznej, Warszawski Uniwersytet Medyczny. 2. Klinika Kardiologii i Nadciśnienia Tętniczego, Centralny Szpital Kliniczny Ministerstwa Spraw Wewnętrznych, Warszawa
Dariusz A. Kosior
1. Klinika Kardiologii i Nadciśnienia Tętniczego, Centralny Szpital Kliniczny Ministerstwa Spraw Wewnętrznych, Warszawa. 2. Zakład Fizjologii Stosowanej, Instytut Medycyny Doświadczalnej i Klinicznej im. M. Mossakowskiego, Polska Akademia Nauk, Warszawa

Abstract

For many years, vitamin K antagonists (VKA) were the only effective oral anticoagulants to prevent and treat thromboembolism. However, their clinical use is limited by many drug interactions, necessity of monitoring and a narrow therapeutic window. The pharmacological response is also unpredictable and highly variable among patients. What is more, the uncorrect use of these drugs may cause haemorrhagic or thromboembolic complications. Recently strongly developing group of drugs are novel oral anticoagulants (NOAC). They are deprived of some of the adverse effects of the VKA with the same effectiveness in prevention of thromboembolism complications. One of this drugs is dabigatran which is reversible, selective thrombin blocker without direct impact on other coagulation factors. In spite of using dabigatran for some time, there exist some clinical situations which require special attention during its use. It concerns hemorrhagic complications as well as procedures in case of their appearance. Similarly, one should remember about necessity of carrying on therapy carefully in case of patients during intraoperative period or patients with liver or kidney function disorders. The aim of this article is to present a proper way of conducting dabigatran therapy in clinical situations mentioned above.

Downloads

Download data is not yet available.

Article Details

How to Cite
Milanowski , Łukasz, Postuła , M., & Kosior , D. A. (2014). Oral thrombin inhibitors in specific situations. Cardiology in Practice, 8(3), 26-33. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1528
Issue
Vol 8 No 3 (2014)
Section
Articles
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)

References

1. Wann L.S., Curtis A.B., January C.T. et al.: 2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2011; 57: 223-242.
2. You J.J., Singer D.E., Howard P.A. et al.: Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl.): e531S-e575S.
3. Fawole A., Daw H., Crowther M.: Practical management of bleeding due to the anticoagulants dabigatran, rivaroxaban and apixaban. Cleve Clin. J. Med. 2013; 80(7): 443-451.
4. Heidbuchel H., Verhamme P., Alings M. et al.: EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur. Heart J. 2013; 27: 2094-2106.
5. Jeffrey D., Wessler M.D., Laura T. et al.: The P-glycoprotein Transport system and Cardiovascular drugs. J. Am. Coll. Cardiol. 2013; 61: 2495-2502.
6. Pernod G., Albaladejo P., Godier A. et al.: Management of major bleeding complications and emergency surgery in patients on long-term treatment with direct oral anticoagulants, thrombin or factor-Xa inhibitors: Proposals of the Working Group on Perioperative Haemostasis (GIHP) – March 2013. Arch. Cardiovasc. Dis. 2013; 106: 382-393.
7. Connolly S.J., Ezekowitz M.D., Yusuf S. et al.; RE-LY Steering Committee and Investigators: Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2009; 361: 1139-1151.
8. Desai J., Kolb J.M., Weitz J.I. et al.: Gastrointestinal bleeding with the new oral anticoagulants – defining the issues and the management strategies. Thromb. Haemost. 2013; 110: 205-212.
9. Abraham N.S., Castillo D.L.: Novel anticoagulants: bleeding risk and management strategies. Curr. Opin. Gastroenterol. 2013; 29(6): 676-683.
10. Spyropoulos A.C., Douketis J.D.: How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood 2012; 120: 2954-2962.
11. Douketis J.D., Spyropoulos A.C., Spencer F.A. et al.: Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e326Se350S999.
12. Camm A.J., Kirchhof P., Lip G.Y. et al.: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010; 12: 1360-1420.
13. Liew A., Douketis J.: Perioperative management of patients who are receiving a novel oral anticoagulant. Intern. Emerg. Med. 2013; 8: 477-484.
14. Hart R.G., Eikelboom J.W., Brimble K.S. et al.: Stroke Prevention in Atrial Fibrillation Patients with Chronic Kidney Disease. Can. J. Cardiol. 2013; 29(7 Suppl): 71-78.
15. Ng K.P., Edwards N.C., Lip G.Y. et al.: Atrial Fibrillation in CKD: Balancing the Risks and Benefits of Anticoagulation. Am. J. Kidney Dis. 2013; 62(3): 615-632.
16. Hylek E.M., Ko D., Cove C.L.: Gaps in translation from trials to practice: non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation. Thromb. Haemost. 2014; 111(5): 783-788.
17. Pruszczyk P., Stepinska J., Banasiak W. et al.: New oral anticoagulants in the prevention of embolic complications in patients with atrial fibrillation. Polish Cardiac Society, Polish Neurological Society and Working Group on Haemostasis of the Polish Society of Haematologists and Transfusiologists consensus statement. Kardiol. Pol. 2012; 9: 979-988.
18. Miesbach W., Seifried E.: New direct oral anticoagulants – current therapeutic options and treatment recommendations for bleeding complications. Thromb. Haemost. 2012; 108(4): 625-632.
19. Thachil J.: Relevance of clotting tests in liver disease. Postgrad. Med. J. 2008; 84(990): 177-181.
20. Deitelzweig S.B., Lin J., Kreilick C. et al.: Warfarin therapy in patients with venous thromboembolism: patterns of use and predictors of clinical outcomes. Adv. Ther. 2010; 27(9): 623-633.
21. Amitrano L., Guardascione M.A., Brancaccio V. et al.: Coagulation disorders in liver disease. Semin. Liver Dis. 2002; 22(1): 83-96.
22. Caldwell S.H., Hoffman M., Lisman T. et al.: Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology 2006; 44(4): 1039-1046.
23. Blech S., Ebner T., Ludwig-Schwellinger E. et al.: The metabolism and disposition of the oral direct thrombin inhibitor, dabigatran, in humans. Drug. Metab. Dispos. 2008; 36(2): 386-399.
24. Caldeira D., Barra M., Santos A.T. et al.: Risk of drug-induced liver injury with the new oral anticoagulants: systematic review and meta-analysis. Heart 2014; January 29 [online: doi: 10.1136/heartjnl-2013-305288].
25. Hochtl T., Huber K.: New anticoagulants for the prevention of stroke in atrial fibrillation. Fundam. Clin. Pharmacol. 2012; 26(1): 47-53.
26. Graff J., Harder S.: Anticoagulant Therapy with the Oral Direct Factor Xa Inhibitors Rivaroxaban, Apixaban and Edoxaban and the Thrombin Inhibitor Dabigatran Etexilate in Patients with Hepatic Impairment. Clin. Pharmacokinet. 2013; 52: 243-254.