Efikasnost novih oralnih antikoagulantnih lekova u prevenciji tromboembolijskih komplikacija kod obolelih od atrijalne fibrilacije

Abstract

Prevention of stroke and systemic embolism is one of the principal treatment goals in patients with atrial fibrillation (AF ). Aspirin and other antiplatelet medications provide only modest protection from AF -related thromboembolism, without significantly reducing the risk of bleeding. Despite proven efficacy and relatively low bleeding risk, stroke prevention with vitamin K antagonists is limited by the narrow therapeutic window and requirements for frequent monitoring of anticoagulation intensity as well as numerous drug-drug interactions. These limitations result in systemic under-use or suboptimal treatment with vitamin K antagonists in every-day clinical practice. Recently, significant advances in AF thromboprophylaxis have been achieved with the introduction of novel oral anticoagulant medications (NOAC s) that act as reversible direct inhibitors of activated thrombin (dabigatran) or activated factor X (rivaroxaban, apixaban and edoxaban) in the blood and exert a stable, dose-dependent pharmacological effect with rapid onset and offset of action, without the need for routine monitoring of anticoagulation intensity. The efficacy of NOAC s for stroke prevention in AF has been confirmed in several large randomized clinical trials. The purpose of this review article is to provide an overview of clinical trial results that have evaluated the efficacy of different modalities of pharmacological thromboprophylaxis in AF, with a focus on NOAC s (dabigatran, rivaroxaban, apixaban and edoxaban) in AF -related stroke prevention.