Updates in Anticoagulation Therapy Monitoring

Abstract

In the past six decades, heparin and warfarin were the primary anticoagulants prescribed for treatment and prophylaxis of venous thromboembolism worldwide. This has been accompanied by extensive clinical knowledge regarding dosing, monitoring, and reversal of these anticoagulants, and the resources required to do so have largely been readily available at small and large centers alike. However, with the advent of newer oral and parenteral anticoagulants such as low molecular weight heparins, factor Xa inhibitors, and direct thrombin inhibitors in recent years, new corresponding practice guidelines have also emerged. A notable shift in the need for monitoring and reversal agents has evolved as well. While this has perhaps streamlined the process for physicians and is often desirable for patients, it has also left a knowledge and resource gap in clinical scenarios for which urgent reversal and monitoring is necessary. An overview of the currently available anticoagulants with a focus on the guidelines and available tests for anticoagulant monitoring will be discussed in this article.

Editorial for the Special Issue of Monitoring Anticoagulants

“…The challenge is to obtain potent enough anticoagulation for treating or preventing thromboembolic complications, without exposing patients to excessive bleeding risk. Therapy monitoring has become inseparable from anticoagulant therapy and is often used to adjust posology while preventing severe bleedings [ 5 , 6 ]. Vitamin K Antagonist and heparin therapy are potent anticoagulant therapies, which impact the activity of a wide scope of coagulation proteins.…”

“…The published reports firstly concern heparin [ 1 ] and its complications [ 2 , 3 ], such as heparin-induced thrombocytopenia (HIT), or direct oral anticoagulants (DOACs) [ 4 ], which specifically and directly inhibit thrombin or factor Xa (FXa). Other articles review the various approaches for testing ancient, current, and new anticoagulants [ 5 , 6 ]; alternatively, they discuss the specific issues related to the management of critically ill patients who are anticoagulated for prophylaxis or for curative treatment of thromboembolic diseases [ 7 ]. Lastly, this issue presents a novel study concerning an anticoagulant protein, thrombomodulin (TM), which is available in the extra-cellular recombinant form as a drug, Recomodulin.…”

Heparin and Its Derivatives: Challenges and Advances in Therapeutic Biomolecules

“…Taken together, these so-called VLMWHs or ultra-low-molecular-weight heparins (ULMWHs), including fondaparinux, showed a higher anti-Xa activity than other heparin macromolecules such as UFH or LMWHs. Therefore, these molecular-size-optimized ULMWHs or LMWHs have shown great potential in clinical applications as drugs with improved therapeutic effects and low toxic effects when compared with large UFHs [ 47 ]. The design of heparin derivatives can be optimized in terms of not only the molecular size and sequence but also the route of administration.…”

A trombose venosa profunda pós-COVID-19 e seu manejo farmacológico

“…Desse modo, as HBPMs, como a enoxaparin, dalteparin, tinzaparin e nadroparin, por exemplo, apresentam uma estrutura molecular menor que as Heparinas Research, Society and Development, v. 11, n. 1, e12311124991, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i1.24991 10 Não Fracionadas. Uma vez que esses fármacos não apresentam a região-C (sequência pentassacarídica + região de ligação com a trombina) em sua composição, a capacidade de modular o fator IIa é reduzida em comparação com as HNFs (Hirsh et al 2001;McRae et al, 2021), promovendo uma coagulação mais branda nos pacientes e menos efeitos colaterais (McRae et al, 2021).…”

“…Entretanto esses compostos têm um padrão farmacocinético previsível, menor chance de desenvolvimento de trombocitopenia relacionada ao seu uso e tempo de meia-vida mais longo, de três a quatro horas (Tang et al, 2020). Tais atributos possibilitam a aplicação desses fármacos apenas uma vez ao dia, de forma mais segura, o que permite menor monitoramento e utilização fora dos médicos (Hirsh et al 2001;McRae et al, 2021;Hull, et al 2021).…”