New anticoagulants for the treatment of venous thromboembolism

Abstract

Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.

Análise do grau de recanalização da trombose venosa profunda: estudo comparativo de pacientes tratados com varfarina versus rivaroxabana

“…One negative aspect of warfarin is its slow onset of action, because its effects are the result of interference in cyclic conversion of vitamin K and its 2.3-epóxido, blocking synthesis of the coagulation factors that are dependent on it (factors II, VII, IX, and X). Its anticoagulant effects do not therefore occur until factors already present in the circulation have been metabolized, which typically takes 36-72 h. 15 Additionally, it has slow clearance, a narrow therapeutic window, and a large number of drug interactions, which means that it is necessary to continuously monitor activated partial thromboplastin time and INR and repeatedly adjust daily doses to achieve the ideal therapeutic dose. 16 Rivaroxaban is an oral anticoagulant that acts as a reversible and specific factor Xa inhibitor.…”

Cancer-associated thrombosis: the when, how and why

“…These new drugs, one direct thrombin inhibitor (dabigatran) and three Xa antagonists (rivaroxaban, apixaban and edoxaban) proved to be, in large randomised controlled trials, at least as effective as the conventional VKA anticoagulant strategy for prevention of VTE recurrence in a general population. Their great advantage, however, was in safety; bleeding rates were significantly reduced with direct oral anticoagulant use [41]. These data led to the indication of direct oral anticoagulants as the first-choice anticoagulation for VTE treatment not related to cancer [33].…”

Drug Interactions in Elderly People Making use of oral Anticoagulants and Hospitalized in a Cardiology Hospital / Interações Medicamentosas nos Idosos em uso de Anticoagulantes Orais Internados num Hospital Cardiológico

“…The subcutaneous or intravenous form is represented mainly by low molecular weight heparins and unfractionated heparin. 12,13 Warfarin is a vitamin K antagonist absorbed in the gastrointestinal tract whose onset occurs after 24 hours of oral administration and may last from 2 to 5 days. Its action peak is around 72 to 96 hours and its half-life time varies from 20 to 60 hours.…”