MEDIX, God. 22 Br. 121/122  •  Pregledni članak  •  Interna medicina HR ENG

Fibrilacija atrija i novi antikoagulansiAtrial fibrillation and novel oral anticoagulants

Šime Manola, Vjekoslav Radeljić, Nikola Pavlović, Karlo Golubić, Ivan Zeljković

Fibrilacija atrija najčešća je aritmija u populaciji s prevalencijom od 1–2% i znatnim porastom incidencije s dobi. Povezana je s povišenim rizikom za moždani udar i srčano popuštanje kao i povišenim mortalitetom i morbiditetom bolesnika. Liječenje fibrilacije može se podijeliti na prevenciju tromboembolije i smanjenje rizika za moždani udar te na kontrolu ritma ili kontrolu frekvencije. Prema današnjim spoznajama, jedino je antikoagulantna terapija nedvojbeno dokazala utjecaj na mortalitet bolesnika. Donedavno, jedina dostupna antikoagulantna terapija bili su antagonisti vitamina K. Međutim, suočeni smo s brojnim nedostatcima takve terapije – interakcije s hranom i lijekovima, spori početak i prestanak djelovanja kao i potrebe za stalnim nadziranjem učinka radi modifikacije doze.Novi antikoagulansi (apiksaban, dabigatran, edoksaban i rivaroksaban) u velikim randomiziranim istraživanjima pokazali su da su neinferiorni ili čak superiorni varfarinu u prevenciji ishemijskoga moždanog udara i sustavne embolije kao i u odnosu na incidenciju velikih krvarenja u bolesnika s nevalvularnom fibrilacijom atrija. Osim kliničke učinkovitosti, moguća prednost navedenih lijekova jest fiksno doziranje, predvidivi učinak, manje interakcije s drugim lijekovima i hranom te brzi početak djelovanja. Novi antikoagulansi apsolutno su kontraindicirani u bolesnika s mehaničkim valvulama i umjerenom ili teškom mitralnom stenozom.

Ključne riječi:
antikoagulantna terapija; fibrilacija atrija; moždani udar; NOAK

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 22 Br. 121/122

Atrial fibrillation (AFib) is the most common arrhythmia in the general population with a prevalence of 1–2% and a significant increase in incidence with age. AFib is related to an increased risk of stroke and heart failure as well as higher mortality and morbidity of patients. AFib treatment can be divided into prevention of thromboembolism and reducing the risk of stroke and into rhythm control or rate control therapy. According to current knowledge, only anticoagulation therapy has undoubtedly been proven to decrease the overall patients’ mortality. Until recently, the only available anticoagulation therapy was vitamin K antagonists. However, we are faced with numerous disadvantages of the latter – interaction with food and drugs, slow effect onset and stop, as well as the need for continuous effect monitoring for the purpose of dosage modification. Novel oral anticoagulants – NOACs (apixaban, dabigatran, rivaroxaban and edoxaban) have shown in large randomized studies the non-inferiority or even superiority to warfarin in the prevention of ischemic stroke and systemic embolism as well as to the incidence of major bleeding in patients with non-valvular atrial fibrillation. In addition to clinical efficiency, the potential advantage of NOACs is fixed dosage, predictable effects, fewer interactions with other medications and food as well as a rapid effect onset. NOACs are absolutely contraindicated in patients with mechanical valves and moderate or severe mitral stenosis.

Key words:
anticoagulation therapy; atrial fibrillation; NOAC; stroke