Situación actual de los nuevos anticoagulantes orales
- García Frade, Luis Javier
- González Mena, Beatriz
- Albarrán Severo, Beatriz
- Andujar Troncoso, Giselle
- Cidoncha Morcillo, Borja
ISSN: 0210-6523
Year of publication: 2013
Issue: 50
Pages: 99-112
Type: Article
More publications in: Anales de la Real Academia de Medicina y Cirugía de Valladolid
Abstract
For more than half a century, vitamin K antagonists have defined oral anticoagulant therapy for the long-term management of thrombotic disorders. Despite its clinical efficacy, vitamin-antagonists have multiple, well-known limitations, including numerous interactions with other drugs and the need for regular blood monitoring and dose adjustments. The alterna- tive new oral anticoagulants that are at least equally efficacious, safer and easier to administer, open a new era in antithrombotic treatment. These agents are directed against either thrombin (Dabigatran) or factor Xa (Rivaroxabán and Apixabán), have a half-life around 12 hours in patients with normal renal function and a time to peak anticoagulant activity of two or three hours. Though thousands of patients have been treated in clinical trials in venous and arterial thrombosis, more experience is needed in ordinary practice. Open questions remain such as how to manage hemorrhage, invasive procedures particularly on emergency, resumption following procedures, need of bridging with heparin, treatment of overdoses and the present absence of antidote.