Anticoagulants in clinical practice. The place of vitamin K antagonists in combination with new oral anticoagulants

Abstract

Thrombotic and thromboembolic complications are associated with activation of blood coagulation and local thrombosis in different parts of the vascular bed. That determines the choice of drugs for the treatment of the existing thrombosis or its prevention. Treatment and secondary prevention of venous thrombosis and cardioembolic complications presupposes administration of anticoagulants such as warfarin, and a group of new drugs - direct blood coagulation inhibitors. Warfarin is effective in blocking thrombogenic activity and in cases of maximum thrombotic risks in patients with artificial heart valve, antiphospholipid syndrome, as well as in groups where no studies of new drugs were conducted. However, warfarin is associated with a number of limitations and requires strict compliance with rules and monitoring. Adverse effects of warfarin are to a certain extent addressed by the new group of anticoagulants - direct inhibitors of coagulation factor, which are registered in Russia for the prevention of venous thromboembolic complications after major orthopedic surgery, prevention of cardioembolic complications of atrial fibrillation, secondary prevention and treatment of venous thrombosis. The feasibility of switching to new drugs for stable patients receiving warfarin is doubtful. For patients just starting anticoagulant therapy, direct inhibitors of coagulation factor should be considered as the first-line treatment.