Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 3-4, Pages: 230-236
https://doi.org/10.2298/SARH1504230A
Full text ( 249 KB)
Contribution of novel anticoagulants fondaparinux and dabigatran to venous thromboembolism prevention
Antonijević Nebojša (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Cardiology, Belgrade)
Kanjuh Vladimir (School of Medicine, Belgrade + Serbian Academy of Sciences and Arts, Committee of Cardiovascular Pathology, Belgrade)
Živković Ivana (Clinical Center of Serbia, Clinic for Cardiology, Belgrade)
Jovanović Ljubica (Clinical Center of Serbia, Clinic for Cardiology, Belgrade)
Vukčević Miodrag (School of Medicine, Belgrade + Medical Center “Bežanijska kosa”, Belgrade)
Apostolović Milan (School of Medicine, Belgrade + Institute for Orthopedic Surgery “Banjica”, Belgrade)
The data that episodes and sequels of venous thromboembolism (VTE) are
recorded in a significant percentage of patients receiving standard
anticoagulants as VTE prophylaxis (unfractionated, low-molecular-weight
heparin and vitamin K inhibitors) as well as the fact that these drugs have
significant limitations and that they may cause serious side-effects in some
patients indicate the need for the introduction of new anticoagulant drugs.
Fondaparinux, a selective inhibitor of Factor Xa, administered following
major orthopedic surgeries having a high risk for the development of VTE, is
more efficient than enoxaparin sodium used in European and North-American
approved doses. The increased incidence of major bleeding (excluding fatal)
due to fondaparinux could be perhaps lowered by dosage reduction in patients
with a mildly decreased creatinine clearance. Dabigatran, a peroral direct
thrombin inhibitor, administered for VTE prophylaxis in elective hip and knee
surgery, showed in to date studies the efficacy comparable (if dabigatran is
given in both dosage regimes of 150 mg and 220 mg daily) or superior (if
dabigatran is given at a dose of 220 mg daily) to enoxaparin administered in
European-approved doses, while North American-approved doses of enoxaparin
were superior than dabigatran in VTE reduction. No significant differences in
bleeding rates were determined in any of the study groups. We consider that
the introduction of new anticoagulants, including fondaparinux and
dabigatran, will contribute to the establishment of a better safety profile
and efficacy, and will also enable adequate therapy individualization for
each patient depending on his/hers clinical characteristics. The introduction
of novel peroral anticoagulants will, inter alia, significantly contribute to
improvement in the quality of life, release the patient from numerous
limitations in nutrition, interreaction, frequent laboratory monitoring, and
also significantly improve therapeutic predictability.
Keywords: prevention, venous thromoembolism, fondaparinux, dabigatran
Projekat Ministarstva
nauke Republike Srbije, br. 173008: Kompleksne bolesti kao model sistem za
proučavanje modulacije fenotipa – strukturna i funkcionalna analiza
molekularnih biomarkera