Eficacia de los Anticoagulantes Orales Directos (DOAC) en la terapia antitrombótica para pacientes con fibrilación auricular no valvular.
Resumen
El objetivo de este estudio es analizar las características de los anticoagulantes orales directos (DOACs) y determinar cuál de ellos es el más adecuado según las características clínicas de cada paciente; para ello, se realizó una búsqueda exhaustiva en MEDLINE a través de la base de datos PUBMED, utilizando términos como "DOACs", "tratamiento de la FA con DOACs", "tratamiento antitrombótico de la fibrilación auricular", "anticoagulantes orales directos", "dabigatrán", "rivaroxabán" y "apixabán". Los resultados obtenidos revelaron que los DOACs reducen la tasa de sangrado en pacientes que requieren anticoagulación, y el apixabán mostró la menor tasa de sangrado y complicaciones cardiovasculares. En conclusión, se requiere un análisis riguroso para determinar el DOAC más adecuado en cada caso.
Citas
Dogliotti, A., Paolasso, E., & Giugliano, R. P. (2013). Novel oral anticoagulants in atrial fibrillation: a meta‐analysis of large, randomized, controlled trials vs warfarin. Clinical Cardiology, 36(2), 61-67.
Eerenberg, E. S., Kamphuisen, P. W., Sijpkens, M. K., Meijers, J. C., Buller, H. R., & Levi, M. (2011). Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation, 124(14), 1573- 1579.
Eikelboom, J. W., & Weitz, J. I. (2010). New anticoagulants. Circulation, 121(13), 1523-1532.
Eriksson, B. I., Quinlan, D. J., & Weitz, J. I. (2009). Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor Xa inhibitors in development. Clinical pharmacokinetics, 48, 1-22.
Frost, C. E., Byon, W., Song, Y., Wang, J., Schuster, A. E., Boyd, R. A., ... & LaCreta, F. (2015). Effect of ketoconazole and diltiazem on the pharmacokinetics of apixaban, an oral direct factor X an inhibitor. British journal of clinical pharmacology, 79(5), 838-846.
Gnoth, M. J., Buetehorn, U., Muenster, U., Schwarz, T., & Sandmann, S. (2011). In vitro and in vivo P-glycoprotein transport characteristics of rivaroxaban. Journal of Pharmacology and Experimental Therapeutics, 338(1), 372-380.
Godier, A., Miclot, A., Le Bonniec, B., Durand, M., Fischer, A. M., Emmerich, J., ... & Samama, C. M. (2012). Evaluation of prothrombin complex concentrate and recombinant activated factor VII to reverse rivaroxaban in a rabbit model. The Journal of the American Society of Anesthesiologists, 116(1), 94-102.
Hashimoto, H., Toide, K., Kitamura, R., Fujita, M., Tagawa, S., Itoh, S., & Kamataki, T. (1993). Gene structure of CYP3A4, an adult‐specific form of cytochrome P450 in human livers, and its transcriptional control. European journal of biochemistry, 218(2), 585-595.
Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Hacke, W., Oldgren, J., ... & Kirchhof, P. (2013). European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace, 15(5), 625-651.
Johansson, S., Cullberg, M., Eriksson, U. G., Elg, M., Dunér, K., Jensen, E., ... & Wåhlander, K. (2011). Single-dose pharmacokinetics, pharmacodynamics and safety of AZD0837, a novel oral direct thrombin inhibitor, in young healthy male subjects. International Journal of Clinical Pharmacology and Therapeutics, 49(4), 258-267.
Kubitza, D., & Haas, S. (2006). Novel factor Xa inhibitors for prevention and treatment of thromboembolic diseases. Expert opinion on investigational drugs, 15(8), 843-855.
Mueck, W., Kubitza, D., & Becka, M. (2013). Co‐administration of rivaroxaban with drugs that share its elimination pathways: pharmacokinetic effects in healthy subjects. British journal of clinical pharmacology, 76(3), 455-466.
Ogata, K., Mendell‐Harary, J., Tachibana, M., Masumoto, H., Oguma, T., Kojima, M., & Kunitada, S. (2010). Clinical safety, tolerability, pharmacokinetics, and pharmacodynamics of the novel factor Xa inhibitor edoxaban in healthy volunteers. The Journal of Clinical Pharmacology, 50(7), 743-753.
Pinto, D. J., Orwat, M. J., Koch, S., Rossi, K. A., Alexander, R. S., Smallwood, A., ... & Lam, P. Y. (2007). Discovery of 1-(4-methoxyphenyl)-7-oxo-6-(4-(2-oxopiperidin-1-yl) phenyl)-4, 5, 6, 7-tetrahydro-1 H-pyrazolo [3, 4-c] pyridine-3-carboxamide (Apixaban, BMS-562247), a highly potent, selective, efficacious, and orally bioavailable inhibitor of blood coagulation factor Xa. Journal of medicinal chemistry, 50(22), 5339-5356.
Raghavan, N., Frost, C. E., Yu, Z., He, K., Zhang, H., Humphreys, W. G., ... & Zhang, D. (2009). Apixaban metabolism and pharmacokinetics after oral administration to humans. Drug metabolism and disposition, 37(1), 74-81.
Scaglione, F. (2013). New oral anticoagulants: comparative pharmacology with vitamin K antagonists. Clinical pharmacokinetics, 52, 69-82.
Shapiro, L. E., & Shear, N. H. (2002). Drug interactions: proteins, pumps, and P-450s. Journal of the American Academy of Dermatology, 47(4), 467-488.
Stangier, J. (2008). Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate. Clinical pharmacokinetics, 47, 285-295.
Stangier, J., Rathgen, K., Stähle, H., Gansser, D., & Roth, W. (2007). The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. British journal of clinical pharmacology, 64(3), 292-303.
Stöllberger, C., & Finsterer, J. (2015). Relevanz von P-Glykoprotein in der schlaganfallprävention mit dabigatran, rivaroxaban und apixaban. Herz, 40, 140-145.
