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Department of Pharmacology
Faculty of Pharmacy
Vojvode Stepe 450
11221 Belgrade, Serbia
New oral anticoagulant drugs in atrial fibrillation and acute coronary syndrome
Aleksandra Novaković1, Tatjana Divac2, Ivan Stojanović3,4, Predrag Milojević3,4, Dragoslav Nenezić3,4
University of Belgrade, Department of Pharmacology, Faculty of Pharmacy, Belgrade, Serbia1
Clinical Centre of Serbia, Belgrade, Serbia2
University of Belgrade, Faculty of Medicine, Belgrade, Serbia3
Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia4
After an acute coronary syndrome, patients remain at risk of recurrent ischemic events despite the use of antiplatelet therapy. In order to reduce the risk of recurrent ischemia in the treatment of patients with acute coronary syndromes, standard oral anticoagulants, such as vitamin K antagonists, have been introduced. These drugs have an important role in preventing stroke and systemic embolism in patients with atrial fibrillation. Vitamin K antagonists (e.g., warfarin) reduce the risk of recurrent cardio-vascular events and stroke but increase the risk of bleeding. In addition, the traditional anticoagulants have other significant drawbacks. Therefore, modulation of the coagulation process represents an important target in the development of new oral anticoagulants today.
The new oral anticoagulants selectively target thrombin (dabigatran etexilate) or factor Xa (rivaroxaban, apixaban, edoxaban). Unlike traditional anticoagulants, these drugs have rapid onset of action and a relatively wide therapeutic range, do not require routine prothrombin time (PT) monitoring and have low potential for food and drug interaction.
Dabigatran etexilate and rivaroxaban have been already approved in many countries for the prevention of stroke and systemic embolism in patients with atrial fibrillation. The third phase of clinical studies in which rivaroxaban was investigated in patients with acute coronary syndrome has been successfully completed. Acta Medica Medianae 2013;52(3):42-48.
Key words: new oral anticoagulants, acute coronary syndrome, atrial fibrillation, thrombin, factor Xa