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Anticoagulantes orais: terapêutica clássica versus novos anticoagulantes
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Abstract(s)
Os novos anticoagulantes orais representam uma inovação terapêutica anticoagulante, tendo obtido recentemente aprovação para várias indicações clínicas. A varfarina foi um dos primeiros anticoagulantes orais a ser desenvolvido, no entanto acarreta inúmeras inconveniências tais como, interações medicamentosas e alimentares, margem terapêutica reduzida, monitorização frequente e variações de resposta entre indivíduos, que comprometem a eficácia do tratamento. Consequentemente, foi necessário investigar outras alternativas surgindo assim os novos anticoagulantes orais, dabigatrano, apixabano e rivaroxabano que detêm menos limitações e a mesma eficácia que os AVK. Estes anticoagulantes são eficientes na profilaxia e tratamento tromboembolismo venoso e na prevenção de AVC em pacientes com fibrilação auricular, contudo também apresentam as suas desvantagens como custo elevado e ausência de antídoto específico.
Nesta revisão bibliográfica serão abordadas as propriedades farmacológicas, mecanismos de ação, vantagens e desvantagens, custos terapêuticos dos anticoagulantes clássicos e novos anticoagulantes, sendo feita uma comparação entre estes de modo a perceber qual será a melhor opção terapêutica.
The new oral anticoagulants represent an innovation in anticoagulant therapy, which has been recently approved for various clinical indications. Warfarin was the first oral anticoagulants to be developed, however entails numerous drawbacks such as drug and food interactions, narrow therapeutic index, frequent monitoring and interindividual response variations that compromise the effectiveness of treatment. Consequently, it was necessary to investigate other alternatives that lead to the discover of new oral anticoagulants, dabigatran, rivaroxaban and apixaban who hold fewer limitations and the same efficacy as the AVK. These anticoagulants are effective in the treatment and prevention of venous thromboembolism and for the prevention of stroke in patients with atrial fibrillation, but also have their disadvantages such as high cost and lack of specific antidote. In this literature review the pharmacological properties will be addressed as well as mechanisms of action, advantages and disadvantages, therapeutic costs of classic and new anticoagulants and a comparison between them in order to understand what the best treatment option is.
The new oral anticoagulants represent an innovation in anticoagulant therapy, which has been recently approved for various clinical indications. Warfarin was the first oral anticoagulants to be developed, however entails numerous drawbacks such as drug and food interactions, narrow therapeutic index, frequent monitoring and interindividual response variations that compromise the effectiveness of treatment. Consequently, it was necessary to investigate other alternatives that lead to the discover of new oral anticoagulants, dabigatran, rivaroxaban and apixaban who hold fewer limitations and the same efficacy as the AVK. These anticoagulants are effective in the treatment and prevention of venous thromboembolism and for the prevention of stroke in patients with atrial fibrillation, but also have their disadvantages such as high cost and lack of specific antidote. In this literature review the pharmacological properties will be addressed as well as mechanisms of action, advantages and disadvantages, therapeutic costs of classic and new anticoagulants and a comparison between them in order to understand what the best treatment option is.
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Novos anticoagulantes Antagonistas da vitamina K Varfarina Fibrilação auricular Anticoagulantes orais Tromboembolismo venoso Dabigatrano Rivaroxabano Apixabano New anticoagulants Vitamin K antagonists Warfarin Atrial fibrillation Oral anticoagulants Venous thromboembolism Dabigatran Rivaroxaban Apixaban