Medicines in prevention and therapy of venous thromboembolism

Abstract

Venous thromboembolism (VTE) is a frequent cause of morbidity and mortality in our country and in the world. In prevention and therapy of VTE antithrombotic drugs and non- pharmacological measures are being used. The use of anticoagulant drugs represents a basis of pharmacological prevention and therapy of VTE. Parenteral anticoagulants (heparin, low- molecular-weight heparins and fondaparinux) are used to achieve fast anticoagulation in acute VTE, as well as for prevention of VTE (i.e. in high-risk surgical patients or in pregnant women). Oral anticoagulants (warfarin, acenocoumarol) are used in therapy of acute VTE, as well as in long-term prevention of VTE, where they have central place. For VTE prophylaxis in patients after hip/knee replacement, the novel oral anticoagulants - dabigatran and rivaroxaban could be used. The use of fibrinolytic drugs is limited to serious VTE. Antiplatelet drugs have modest efficacy and are generally not recommended for VTE prophylaxis. In new clinical studies (WARFASA and ASPIRE) it was demonstrated that aspirin could be useful in secondary prevention of VTE and overall (arterial and venous) thrombotic events in patients who have completed anticoagulant treatment of first episode of VTE. It remains to be seen whether the results of these trials would change the recommendations and clinical practice in regard of aspirin use in secondary prevention of VTE.

Venski tromboembolizam (VTE) je čest uzrok morbiditeta i mortaliteta kod nas i u svetu. U prevenciji i terapiji VTE koriste se antitrombotski lekovi i nefarmakološke mere. Okosnicu farmakološke prevencije i terapije VTE čine antikoagulansi. Parenteralni antikoagulansi (heparin, niskomolekularni heparini, fondaparinuks) daju se za brzu antikoagulaciju u akutnom VTE, kao i za prevenciju VTE (npr. kod visokorizičnih hirurških pacijenata ili kod trudnica). Oralni antikoagulansi (varfarin, acenokumarol) daju se u terapiji akutne VTE, kao i u dugotrajnoj prevenciji VTE, gde zauzimaju centralno mesto. Za prevenciju VTE kod pacijenata nakon zamene kuka/kolena mogu se koristiti novi oralni antikoagulansi - dabigatran i rivaroksaban. Primena fibrinolitika ograničena je na teške slučajeve VTE. Antiagregacioni lekovi imaju skromnu efikasnost i generalno se ne preporučuju za prevenciju VTE. U novijim kliničkim studijama (WARFASA i ASPIRE) pokazano jeda aspirin može biti koristan u prevenciji rekurentne VTE, kao i prevenciji ukupnih (arterijskih i venskih) trombotičnih događaja, u pacijenata koji su završili antikoagulantnu terapiju prve epizode VTE. Ostaje da se vidi da li će rezultati ovih studija značajno promeniti preporuke i kliničku praksu u pogledu primene aspirina u sekundarnoj prevenciji VTE.