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Inicio Medicina Clínica (English Edition) Direct oral anticoagulants: An update
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Vol. 151. Issue 5.
Pages 198-206 (September 2018)
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Vol. 151. Issue 5.
Pages 198-206 (September 2018)
Review
DOI: 10.1016/j.medcle.2018.07.005
Direct oral anticoagulants: An update
Anticoagulantes orales directos: puesta al día
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Ana Isabel Franco Moreno
Corresponding author
aifranco@torrejonsalud.com

Corresponding author.
, Rosa María Martín Díaz, María José García Navarro
Servicio de Medicina Interna, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
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Table 1. Efficacy and safety of direct oral anticoagulants in phase III clinical trials in the prevention of embolism of cardiac origin in non-valvular atrial fibrillation, in the acute treatment of venous thromboembolism and in secondary prevention of acute coronary syndrome.
Table 2. Approved indications for direct oral anticoagulants and dose regimens.
Table 3. Monitoring methods for direct oral anticoagulants.
Table 4. Drug interactions of direct oral anticoagulants.
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Abstract

Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In randomized controlled trials comparing direct oral anticoagulants with traditional vitamin K antagonists, the direct oral anticoagulants all showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromboembolism and acute coronary syndrome. In 2008, dabigatran was the first direct oral anticoagulant approved by the European Medicine Agency. Subsequently, rivaroxaban, apixaban and edoxaban were also authorized. This article reviews the evidence related to the use of these drugs.

Keywords:
Anticoagulant treatment
Vitamin K antagonists
Dabigatran etexilate
Rivaroxaban
Apixaban
Edoxaban
Resumen

Durante medio siglo los antagonistas de la vitamina K han sido la única opción disponible para la terapia anticoagulante oral. En los últimos años se han desarrollado anticoagulantes orales directos: un inhibidor directo de la trombina (dabigatrán etexilato) y 3 inhibidores directos del factor X activado (rivaroxabán, apixabán y edoxabán). Todos ellos han demostrado un beneficio-riesgo favorable, comparables en eficacia y seguridad a los anticoagulantes tradicionales antagonistas de la vitamina K, en la prevención del ictus y la embolia sistémica en pacientes con fibrilación auricular no valvular, la profilaxis y el tratamiento del tromboembolismo venoso y el síndrome coronario agudo. En 2008 la Agencia Europea del Medicamento aprobó el primer anticoagulante oral directo, dabigatrán. Posteriormente, rivaroxabán, apixabán y edoxabán fueron autorizados. En este artículo se revisa la experiencia acumulada con cada uno de estos fármacos.

Palabras clave:
Tratamiento anticoagulante
Antagonistas de la vitamina K
Dabigatrán etexilato
Rivaroxabán
Apixabán
Edoxabán

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