| Popis: |
Direct oral anticoagulants (NOAC) that specifically target a single coagulation factor (such as Factor Xa or thrombin) have been developed in recent years to overcome the limitations of established anticoagulants, such as vitamin K antagonists (VKAs). Direct oral anticoagulants, unlike VKAs, have been shown to have predictable pharmacokinetics and pharmacodynamics, a low potential for drug–drug interactions, and are given at fixed doses without the need for routine coagulation monitoring. Rivaroxaban is an oral, direct Factor Xa inhibitor that targets free and clot-bound Factor Xa and Factor Xa in the prothrombinase complex. Rivaroxaban is indicated for the prevention of stroke and systemic embolism in adults with non- valvular atrial fibrillation (AF), for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adult patients, prevention of venous thromboembolism (VTE) in adults undergoing elective hip or knee replacement surgery and for the prevention of atherothrombotic events in adult patients with acute coronary syndrome (ACS) who have elevated cardiac biomarkers, combined with aspirin (acetylsalicylic acid) with or without clopidogrel or ticlopidine. There is no specific antidote available at present for rivaroxaban for use in emergency situations. That is one of the reasons that it is still not accepted for the broader use by clinicians. The other reason is a high price that is defined by the HZZO guidelines for prescribing NOACs. There are sill no randomized trials where NOACs were directly compared. Those kind of studies that would directly compare NOACs mutually, examine their potential differences and peculiarities would help greatly in the process of selection of certain NOAK and their optimal and safer introduction to therapy. |
