Page 66 - GALENIKA MEDICAL JOURNAL

Zaključak

Venska tromboembolijska bolest je jedan od vodećih uzroka morbiditeta i mortaliteta.
Pravovremena dijagnostika i liječenje značajno poboljšavaju ishod bolesti. Osnova liječenja je
primjena antikoagulantne terapije. Decenijama su antagonisti vitamin K bili jedini izbor oralnih
antikoagulanasa, ali zbog mnogobrojnih nedostataka novi, odnosno direktni oralni antikoagulansi,
su dobili primat u liječenju zbog svojih farmakoloških karakteristika. DOAC su lijekovi prvog izbora

ukoliko nisu kontraindikovani. Efikasnost i bezbjednost DOAC potvrđena je nizom multicentričnih
randomizovanih studija i meta-analiza. Mogu se propisati i kod bolesnika sa malignom bolešću,
a zbog svog brzog dejstva olakšavaju vanbolničko liječenje VTE ili mogu da skrate vrijeme
hospitalizacije.

Abstract

Venous thromboembolic disease, which includes pulmonary thromboembolism and deep vein thrombosis, is one of the
most common causes of morbidity and mortality. Management of patients with acute pulmonary thromboembolism is
challenging, due to the wide spectrum of clinical presentation and possible outcomes. Certainly, anticoagulant therapy
is the basis of treatment for these patients. Until recently, parenteral anticoagulants and oral vitamin K antagonists were
used to achieve an anticoagulant effect. These drugs still have their place in the treatment of venous thromboembolic
disease, but new, i.e. direct oral anticoagulants have replaced oral vitamin K antagonists due to their more favorable
pharmacological characteristics. In this paper, based on available literature, clinical trials and good clinical practice
guidelines, we highlight critical errors and discuss potential advantages and disadvantages of oral anticoagulants.

Keywords: pulmonary thromboembolism, venous thromboembolic disease, oral anticoagulants, direct oral anticoagulants
(DOAC)

Literatura 8. Paul C, Baby M, Antrapher AR, Krishnakumar K. NOACs: An emerging
class of oral anticoagulants-a review article. Future Journal of
Pharmaceutical Sciences. 2020; 6:95.
1. Fishman's Pulmonary Diseases and Disorders, 2-Volume Set. 6th 9. Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson
Edition. Mc Graw and Hill. November 30, 2022. H, et al; RE-COVER Study Group. Dabigatran versus warfarin in the
2. Singer AJ, Thode HC Jr, Peacock WF 4th. Admission rates for emergency treatment of acute venous thromboembolism. N Engl J Med. 2009 Dec
department patients with venous thromboembolism and estimation 10;361(24):2342-52.
of the proportion of low risk pulmonary embolism patients: a US 10. Schulman S, Kearon C, Kakkar AK, Schellong S, Eriksson H, Baanstra
perspective. Clin Exp Emerg Med. 2016 Sep 30;3(3):126-131. D, et al; RE-MEDY Trial Investigators; RE-SONATE Trial Investigators.
3. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola Extended use of dabigatran, warfarin, or placebo in venous
VP, et al; The Task Force for the diagnosis and management of acute thromboembolism. N Engl J Med. 2013 Feb 21;368(8):709-18.
pulmonary embolism of the European Society of Cardiology (ESC). 2019 11. Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti
ESC Guidelines for the diagnosis and management of acute pulmonary P, et al; RE-COVER II Trial Investigators. Treatment of acute venous
embolism developed in collaboration with the European Respiratory thromboembolism with dabigatran or warfarin and pooled analysis.
Society (ERS): The Task Force for the diagnosis and management of Circulation. 2014 Feb 18;129(7):764-72.
acute pulmonary embolism of the European Society of Cardiology (ESC).
Eur Respir J. 2019 Oct 9;54(3):1901647. 12. Zhou Y, Yao Z, Zhu L, Tang Y, Chen J, Wu J. Safety of Dabigatran as
4. Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug K, an Anticoagulant: A Systematic Review and Meta-Analysis. Front
Pharmacol. 2021 Feb 2;12:626063.
Geersing GJ, et al. Antithrombotic Therapy for VTE Disease: Second
Update of the CHEST Guideline and Expert Panel Report. Chest. 2021 13. EINSTEIN Investigators; Bauersachs R, Berkowitz SD, Brenner B, Buller
Dec;160(6):e545-e608. HR, Decousus H, Gallus AS, et al. Oral rivaroxaban for symptomatic
venous thromboembolism. N Engl J Med. 2010 Dec 23;363(26):2499-510.
5. Vladislav M. Varagic. Farmakologija. XX prerađeno i dopunjeno izdanje.
Beograd: Elit-Medica. 2005. 14. Romualdi E, Donadini MP, Ageno W. Oral rivaroxaban after symptomatic
6. Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on venous thromboembolism: the continued treatment study (EINSTEIN-
extension study). Expert Rev Cardiovasc Ther. 2011 Jul;9(7):841-4.
management and controversies. BMJ. 2020 Aug 5;370:m2177.
15. Weitz JI, Lensing AWA, Prins MH, Bauersachs R, Beyer-Westendorf J,
7. Panahi L, Udeani G, Horseman M, Weston J, Samuel N, Joseph M, et al. Bounameaux H, et al; EINSTEIN CHOICE Investigators. Rivaroxaban or
Anticoagulants in the Management of Pulmonary Embolism. In: Stojšić Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J
J (Ed), New Knowledge about Pulmonary Thromoboembolism, London: Med. 2017 Mar 30;376(13):1211-22.
IntechOpen. 2021.
64 DOI: 10.5937/Galmed2305062O