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Mekaj YH, Mekaj AY, Duci SB, et al. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag. 2015;11:967-77doi: 10.2147/TCRM.S84210.
Mekaj, Y. H., Mekaj, A. Y., Duci, S. B., & Miftari, E. I. (2015). New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Therapeutics and clinical risk management, 11967-77. https://doi.org/10.2147/TCRM.S84210
Mekaj, Ymer H, et al. "New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events." Therapeutics and clinical risk management vol. 11 (2015): 967-77. doi: https://doi.org/10.2147/TCRM.S84210
Mekaj YH, Mekaj AY, Duci SB, Miftari EI. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag. 2015 Jun 24;11:967-77. doi: 10.2147/TCRM.S84210. eCollection 2015. PMID: 26150723; PMCID: PMC4485791.
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Ther Clin Risk Manag. 2015 Jun 24;11:967-77. doi: 10.2147/TCRM.S84210. eCollection 2015.

New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events.

Therapeutics and clinical risk management

Ymer H Mekaj, Agon Y Mekaj, Shkelzen B Duci, Ermira I Miftari

Affiliations

  1. Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo ; Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, Prishtina, Kosovo.
  2. Clinic of Neurosurgery, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo, Prishtina, Kosovo.
  3. Clinic of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Prishtina.
  4. The Hospital and University Clinical Service of Kosovo, Prishtina, Kosovo.

PMID: 26150723 PMCID: PMC4485791 DOI: 10.2147/TCRM.S84210

Abstract

Despite the discovery and application of many parenteral (unfractionated and low-molecular-weight heparins) and oral anticoagulant vitamin K antagonist (VKA) drugs, the prevention and treatment of venous and arterial thrombotic phenomena remain major medical challenges. Furthermore, VKAs are the only oral anticoagulants used during the past 60 years. The main objective of this study is to present recent data on non-vitamin K antagonist oral anticoagulants (NOACs) and to analyze their advantages and disadvantages compared with those of VKAs based on a large number of recent studies. NOACs are novel direct-acting medications that are selective for one specific coagulation factor, either thrombin (IIa) or activated factor X (Xa). Several NOACs, such as dabigatran (a direct inhibitor of FIIa) and rivaroxaban, apixaban and edoxaban (direct inhibitors of factor Xa), have been used for at least 5 years but possibly 10 years. Unlike traditional VKAs, which prevent the coagulation process by suppressing the synthesis of vitamin K-dependent factors, NOACs directly inhibit key proteases (factors IIa and Xa). The important indications of these drugs are the prevention and treatment of deep vein thrombosis and pulmonary embolisms, and the prevention of atherothrombotic events in the heart and brain of patients with acute coronary syndrome and atrial fibrillation. They are not fixed, and dose-various strengths are available. Most studies have reported that more advantages than disadvantages for NOACs when compared with VKAs, with the most important advantages of NOACs including safety issues (ie, a lower incidence of major bleeding), convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring. Nonetheless, there are some conditions for which VKAs remain the drug of choice. Based on the available data, we can conclude that NOACs have greater advantages and fewer disadvantages compared with VKAs. New studies are required to further assess the efficacy of NOACs.

Keywords: direct IIa and Xa inhibitors; novel oral anticoagulants; venous thromboembolism; vitamin K antagonist

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