RESUMEN
Only vitamin K antagonists could be applied as oral anticoagulants over the past six decades. Coumarols have narrow therapeutic range, and unpredictable anticoagulant effects are resulted by multiple drug interactions. Therefore, regular routine monitoring of the international normalized ratio is necessary. There are two groups of factor-specific anticoagulants: molecules with anti-FIIa (dabigatran) and anti-FXa (rivaroxaban, apixaban and edoxaban) effect. Author summarizes the most important clinical features of the new oral anticoagulants, their indications and the possibilities of laboratory controls. Bleedings are the most important side effects of anticoagulants. This review summarizes the current published evidences for new oral anticoagulants reversal (non-specific and specific) agents, especially in cases with severe acute bleedings or urgent surgery procedures. It reports on how to use inhibitors, the recommended doses and the most important clinical results. The review focuses on idarucizumab - already approved by the U.S. Food and Drug Administration and the European Medicines Agency - which has a key role as the first specific inhibitor of dabigatran.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Antídotos/uso terapéutico , Dabigatrán/antagonistas & inhibidores , Hemorragia/tratamiento farmacológico , Procedimientos Quirúrgicos Operativos , Enfermedad Aguda , Administración Oral , Atención Ambulatoria , Antitrombinas/administración & dosificación , Antitrombinas/efectos adversos , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Factor Xa , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/efectos adversos , Hemorragia/inducido químicamente , Humanos , Pirazoles/antagonistas & inhibidores , Piridinas/antagonistas & inhibidores , Piridonas/antagonistas & inhibidores , Proteínas Recombinantes , Rivaroxabán/antagonistas & inhibidores , Índice de Severidad de la Enfermedad , Tiazoles/antagonistas & inhibidoresRESUMEN
Atherosclerosis is a systemic disease affecting the coronary, carotid, intracerebral, renal and peripherial arteries. The early morphological and functional impairments could be detected in the second or third decades of life and their progression depend on the number and severity of risk factors and individual susceptility. Although the vascular risk factors (smoking, overweight, age, unhealthy diet, lack of physical exercise, hypertension, diabetes mellitus, chronic kidney disease and dyslipidemia) are the same and common in the different vascular diseases, the present clinical routine artificially classifies the diagnosis and therapy of different vascular diseases into different subfields of medicine with the negative impact of possible polypragmasia. Recently, worldwide health surveys (e.g. REACH registry) have proven the usefulness of a holistic approach in the diagnosis and therapy of multiorgan-affected vascular patients. This review summarizes the multidisciplinary advances and future perspective of vascular diseases.