Il laboratorio e i nuovi anticoagulanti orali

AUTORI

ABSTRACT

Laboratory and new oral anticoagulants

Heparins and vitamin K antagonists are drugs of choice for treatment and prevention of thrombotic pathologies. These drugs have a considerable degree of safety and efficacy, but they may present certain drawbacks, as they require frequent laboratory monitoring (unfractionated heparins and anti-vitamin K) or intravenous or subcutaneous administration (low molecular weight heparins). Due to these reasons, several studies have been performed to identify new anticoagulant drugs with characteristics of safety, efficacy and possibility of oral administration and no need of laboratory monitoring. New direct oral anticoagulants (DOAs) have as direct target thrombin (factor IIa) or factor-Xa inhibition; their safety and efficacy have been investigated in several phase III studies. DOAs in most advanced stage of release are dabigatran, rivaroxaban and apixaban; the first drug is a direct thrombin inhibitor, the others are direct factor-Xa inhibitors. DOAs do not require routine laboratory monitoring due to their high dose-response predictability; there is, however, a necessity to measure their anticoagulant effect in some particular situations. In those situations, it is important for the laboratory to consider: 1) how DOAs can interfere in the measurement of basic and more specialistic coagulation parameters; 2) which tests are the most suitable to detect the presence of the new drug; 3) which tests are the most useful to measure the anticoagulant effect; 4) which tests are the most suitable to monitor the antagonizing effect of some drugs (“reversal”) in case of DOA overdose.

BIBLIOGRAFIA