Abstract
Vitamin K antagonists represented for more than 50 years the only oral anticoagulant treatment option, though encumbered by numerous food and drug interactions, with direct impact on the safety and efficacy of this treatment. The frequent complications of anticoagulant treatment with vitamin K antagonists led to the need for the emergence of new oral anticoagulants (NOAC). The main NOACs used today are dabigatran, rivaroxaban and apixaban. NOAC have a number of advantages over antivitamin K anticoagulants: fewer drug interactions, no food interactions, rapid onset of the anticoagulant action, rapid clearance, no need for INR monitoring. NOAC therapy must be individualized according to patient age, comorbidities and medical history, renal function, concomitant medications. Given that clinical experience with NOAC is still limited in practice, physicians (including family physicians) must monitor these patients and need to pay attention and report any side effects.
Highlights
Antagoniştii de vitamina K au reprezentat timp de peste 50 de ani singura opţiune de tratament anticoagulant oral, deşi grevată de numeroase interacţiuni alimentare şi medicamentoase, cu impact direct asupra siguranţei şi eficacităţii acestui tratament
Dovezile referitoare la dabigatran au provenit din studiul RE-LY (Randomized Evaluation of Long-term anticoagulant therapY with dabigatran etexilate trial)
anticoagulante orale noi (ACON) se regăsesc din ce în ce mai des în schemele de tratament ale pacienţilor cu indicaţie de anticoagulare orală din România, fie din motive justificate clinic, fie la solicitarea pacienţilor ori ca urmare a dificultăţii monitorizării INR-ului la pacienţii aflaţi în tratament cu acenocumarol
Summary
Antagoniştii de vitamina K au reprezentat timp de peste 50 de ani singura opţiune de tratament anticoagulant oral, deşi grevată de numeroase interacţiuni alimentare şi medicamentoase, cu impact direct asupra siguranţei şi eficacităţii acestui tratament. În general, iniţierea tratamentului anticoagulant oral, fie cu antivitamine K, fie cu ACON, se face de către medicul specialist cardiolog, internist sau neurolog, medicul de familie are rolul de a monitoriza acest tratament din punct de vedere al eficienţei, siguranţei şi posibilelor complicaţii care pot apărea.
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