Pharmacogenetics of oral anticoagulant therapy
نویسنده
چکیده
Introduction In the last 70 years the antagonists of vitamin K (AVK) were the only therapeutic solution for oral anticoagulation in primary and secondary prophylaxis of arterial and venous thrombosis. The utility of AVK was demonstrated in many situations and presently they are taken by millions patients in the entire world. Many clinical and lab studies contributed to understanding of AVKs’ pharmacokinetics and pharmacodynamics. Several studies were focused on the difficulty of AVK therapy management, more exactly on clinical and lab monitoring and on rapid methods of inhibiting their effects in case of overdose. Recently new oral anticoagulants (OAs) were authorized for commercialization: direct thrombin inhibitor (dabigatran exilate) and inhibitor of factor Xa inhibitor (rivaroxaban). The high cost of these new OAs and the lack of a specific antidote in case of hemorrhagic accidents, make AVKs treatment still the primary option. Acenocoumarol, warfarin and phenprocoumon are the most frequently used AVKs in the entire world. The fact that these drugs are among the top 5 substances that produce the most severe side effects is a paradox. Their therapeutic index is narrow. For a physician prescribing AVK, the main problem is to elaborate an adequate protocol for every patient. New ways of improving the management of AVK therapy are needed in order to ease the work of clinicians and to raise the safety of OAs.
منابع مشابه
Pharmacogenetics of Warfarin
วารสารโลหติวทิยาและเวชศาสตร บรกิารโลหติ ป ที ่ 16 ฉบบัที ่ 3 กรกฎาคม-กนัยายน 2549 Warfarin is the mainstay of anticoagulation therapy. It is used for the prevention and treatment of venous thromboembolism, myocardial infarction, and strokes.1 Its clinical use, however, is complicated by the fact that it has a narrow therapeutic index with associated adverse effects that are potentially serious,...
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