“Oral anticoagulant therapy. Antithrombotic therapy and prevention of thrombosis.”1
Background: The objective of this article is to summarize the published literature concerning the pharmacokinetics and pharmacodynamics of oral anticoagulant drugs that are currently available for clinical use and other aspects related to their management.
Methods: We carried out a standard review of published articles focusing on the laboratory and clinical characteristics of the vitamin K antagonists; the direct thrombin inhibitor, dabigatrán etexilate; and the direct factor Xa inhibitor, rivaroxaban.
Results: The antithrombotic effect of each oral anticoagulant drug, the interactions, and the monitoring of anticoagulation intensity are described in detail and discussed without providing specific recommendations. Moreover, we describe and discuss the clinical applications and optimal dosages of oral anticoagulant therapies, practical issues related to their initiation and monitoring, adverse events such as bleeding and other potential side effects, and available strategies for reversal.
Conclusions: There is a large amount of evidence on laboratory and clinical characteristics of vitamin K antagonists. A growing body of evidence is becoming available on the first new oral anticoagulant drugs available for clinical use, dabigatran and rivaroxaban.
Comentario
Este artículo presenta una revisión completa de los siguientes anticoagulantes orales: fármacos antivitamina K, dabigatrán etexilato y rivaroxabán. En esta guía se habla de la farmacocinética, farmacodinamia, interacciones, efectos secundarios, monitorización, indicaciones y otros aspectos importantes de estos fármacos.
Recomendamos consultar esta guía si se quiere ampliar la información sobre los fármacos antivitamina K. También se habla de los anticoagulantes orales directos dabigatrán etexilato y rivaroxabán, que tendrán un apartado propio en este curso. Ni el apixabán ni el edoxabán fueron incluídos en esta revisión ya que fue publicada antes de la comercialización de dichos fármacos.
(1) Ageno W, Gallus AS, Wittkowsky A, et al. Oral anticoagulant therapy. Antithrombotic therapy and prevention of thrombosis. 9th ed: American College of Chest Physicians. Evidence-based clinical practice guidelines. Chest 2012; 141(2)(Suppl):e44S–e88S.
