Abstract
Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery, especially in orthopedics. Recently, new oral anticoagulants were introduced in the therapeutic arsenal. This fact is important, because the current drug of choice in clinical practice is enoxaparin, a low molecular weight heparin. As all injecting drugs, enoxaparin may reduce patients' adherence to treatment by dissatisfaction with and resistance to the administration. This article reviews the available literature on the overall utility of these innovative medicines, approaching the pharmacology, the compared efficacy in relation to current agents, and the potential targets for new agents, as well as points to new trends in research and development. The article also contributes with a practical guide for use and recommendations to health professionals, especially focusing on the reversibility of hemorrhagic events, and discusses the importance of convenience/satisfaction of use, the cost of treatment, and the risk-benefit profile for patients.
Highlights
All drug therapy needs to satisfy several requirements for good quality in health care
Anticoagulant therapy is recommended for the long-term prevention of ischemic stroke in patients with atrial fibrillation and for the prevention of recurrent myocardial infarction in patients with acute coronary syndromes (ACSs), such as unstable angina or non-ST elevated myocardial infarction (Turpie, 2007)
Clinical studies comparing the efficacy of rivaroxaban and enoxaparin in reducing cases of venous thromboembolism (VTE) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgeries showed a significant reduction of 50% in the cases of VTE between groups treated with rivaroxaban when compared with enoxaparin-treated groups
Summary
All drug therapy needs to satisfy several requirements for good quality in health care. Thesearch for anticoagulants with acceptable efficacy and safety associated with patient compliance has been extensive, and several drugs were developed. Despite the extensive use of heparin and low molecular weight heparins (LMWHs) in thromboprophylaxis after orthopedic surgeries, the subcutaneous administration decreases patient adherence to treatment, which is viewed with concern by health professionals involved in drug therapy. The development of oral anticoagulants which are able to replace heparin and LMWHs, with improved safety and efficacy compared to warfarin, is a matter of great expectation. This review article aims to inform health professionals about the development of anticoagulant drugs and their use in patients who underwent orthopedic surgeries. This paper comprises the relevance of new oral anticoagulants) as dabigatran and rivaroxaban, formulating a practical guide for use, as well as new trends in research and development
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