MEDIX, God. 20 Br. 112  •  Sponzorirani članak  •  Kardiologija HR ENG

Novi oralni antikoagulansi u prevenciji moždanog udara u bolesnika s nevalvularnom fibrilacijom atrija: jednom ili dvaput na dan?The new oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: once or twice daily?

Krešimir Štambuk

Fibrilacija atrija znatno povećava rizik za ishemijski moždani udar. Antikoagulantna terapija jedina je terapijska mjera koja poboljšava prognozu u tih bolesnika, odnosno smanjuje smrtnost i pobol. Novi oralni antikoagulansi (NOAC-i) u odnosu na antagoniste vitamina K pokazali su se barem podjednako učinkovitima, ali i sigurnijima u smislu fatalnih i intrakranijalnih krvarenja. Iako postoje neke farmakološke podudarnosti između pojedinih NOAC-a, različiti NOAC-i imaju različite režime doziranja koji se ne mogu objasniti samo farmakološkim svojstvima. Tako se dabigatran u bolesnika s fibrilacijom atrija primjenjuje dvaput na dan, rivaroksaban jednom na dan, a učinkovitost i sigurnost takve primjene dokazane su u studijama faze III. U neovisnom je ispitivanju doziranje rivaroksabana jednom na dan pokazalo bolje pridržavanje i bolje ustrajanje pri uzimanju terapije u odnosu na lijekove s doziranjem dvaput na dan, što dodatno može smanjiti rizik tromboembolijskih događaja u tih bolesnika. 

Ključne riječi:
antikoagulantna terapija; fibrilacija atrija; rivaroksaban; režim doziranja

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 20 Br. 112

Atrial fibrillation significantly increases the risk of ischemic stroke. Anticoagulant therapy is the only therapeutic measure that improves prognosis and decreases mortality and morbidity in patients with atrial fibrillation. Novel oral anticoagulants (NOACs) have proven to be at least as effective as vitamin K antagonists, but with a better safety profile in terms of fatal and intracranial hemorrhages. Although there are certain pharmacological congruencies among NOACs, different NOACs have different dosing regimens which cannot be explained purely by their pharmacological characteristics. In patients with atrial fibrillation, the dosing regimen for dabigatran is twice daily, rivaroxaban once daily, and the efficacy and safety of these dosing regimens has been confirmed in the phase III clinical trials. Independent study has shown that the dosing regimen of rivaroxaban, once daily, results in better compliance and higher medication persistence compared to the dosing regimen of drugs taken twice daily, which could additionally decrease the risk of thromboembolic events in these patients. 

Key words:
anticoagulant therapy; atrial fibrillation; dosing regimen; rivaroxaban