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Consideraciones prácticas para el uso de los nuevos anticoagulantes orales Translated title: Practical considerations for the use of new oral anticoagulants

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      Abstract

      A pesar de la eficacia comprobada acerca del uso de warfarina como terapia anticoagulante, las múltiples interacciones, el estrecho margen terapéutico y la necesidad de monitorización seriada han planteado el escenario para el desarrollo de nuevos medicamentos como dabigatran, rivaroxaban y apixaban que ofrecen nuevas alternativas para el tratamiento del paciente anticoagulado. El conocimiento de las características farmacológicas y farmacocinéticas así como el contexto específico en el cual pueden usarse se convierten en una necesidad para los médicos que se enfrentan a este tipo de pacientes.

      Translated abstract

      Despite the proven efficacy on the use of warfarin as anticoagulant therapy, the multiple interactions, narrow therapeutic index and the need for serial monitoring have raised the need for the development of new drugs such as dabigatran, rivaroxaban and apixaban, that offer new alternatives for treating the anticoagulated patient. Knowledge of the pharmacologic and pharmacokinetic characteristics and the specific context in which they can be used become a necessity for physicians faced with these patients.

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      Most cited references 16

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      Pharmacologic properties of the new oral anticoagulants: a clinician-oriented review with a focus on perioperative management.

       J D Douketis (2009)
      The past decade has witnessed an explosion in the clinical development of new orally-administered anticoagulant drugs aimed at complementing vitamin K antagonists and heparins for the prevention and treatment of venous thromboembolism, for the prevention of stroke in patients with chronic atrial fibrillation, and for treatment of acute coronary syndromes. This review will focus on those new oral anticoagulants that are most relevant to the practicing clinician. These drugs consist of dabigatran, a direct thrombin inhibitor and rivaroxaban, a factor Xa inhibitor, both of which have been recently approved for clinical use. In addition, apixaban will be reviewed, which is another factor Xa inhibitor that is in the final stages of clinical development. The objectives of this review are: 1) to provide a clinician-oriented overview of the key pharmacokinetic and pharmacodynamic properties of dabigatran, rivaroxaban and apixaban; 2) to consider the implications of these drugs' pharmacologic properties in the perioperative setting for patients who require elective or urgent surgery, focusing on pre- and post-operative dosing, laboratory monitoring and reversal of anticoagulant effect.
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        New oral anticoagulants: a practical guide for clinicians.

        The search for an oral anticoagulant with acceptable efficacy and safety in the treatment and prevention of venous and arterial thromboembolism, but with practical advantages over warfarin, has been a focus of drug development for many years. Three oral agents, dabigatran, rivaroxaban, and apixaban, are nearing approval in the US. Their use in practice will be guided by the clinical trials available, as well as their pharmacokinetic and pharmacodynamic properties. Practitioners need to be fully aware of these characteristics in order to use these agents appropriately in clinical practice. This review compares the results of the phase 3 trials investigating these agents in the prevention of venous thromboembolism in patients undergoing orthopedic surgery, examines the reporting of bleeding complications in the trials, and highlights various practical considerations regarding their use in clinical practice.
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          Dabigatran versus warfarin in patients with atrial fibrillation

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            Author and article information

            Affiliations
            [1 ] CES Cardiología Colombia
            [2 ] Hospital Pablo Tobón Uribe Colombia
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            rcca
            Revista Colombiana de Cardiología
            Rev. Colomb. Cardiol.
            Sociedad Colombiana de Cardiologia. Oficina de Publicaciones (Bogota )
            0120-5633
            June 2012
            : 19
            : 3
            : 135-141
            S0120-56332012000300006

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Colombia
            Categories
            CARDIAC & CARDIOVASCULAR SYSTEMS

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