Martínez-Murillo C, Quintana-González S

Language: Spanish
References: 18
Page: 25-28
PDF size: 50.59 Kb.

ABSTRACT

Antithrombotics are groups of important drugs. All branches of the current medical practice use them. Oral anticoagulants inhibit vitamin K reductases, a group of hepatic enzymes required to activate vitamin K. There are two different drugs: acenocoumarin and warfarin both with a wide range of biological variation. Monitoring of the effect of oral anticoagulants is performed with the INR. Non-fractionated heparin NFH and its derivatives, the low molecular weight heparins (LMWHs), are the best antithrombotics if a fast anticoagulant effect is desired. Since NFH has limitations as compared with LMWH, it is used in hospitalized patients in order to be properly monitored and adjusted because its effect is quite unpredictable. A close monitoring is required to assure an appropriate effect by using the activated partial thromboplastin test which must oscillate between 1.5 and 2.5 times the control. Incidence of hemorrhage varies from 0.8 to 2.4%. LMWHs are replacing NFH in thromboprophylaxis. They inhibit factor Xa more than factor IIa. LMWHs are groups of different, non- interchangeable drugs with wide variation in terms of antithrombotic capacity and hemorrhagic risk associated. They have several advantages over NFH: best pharmacokinetics, longer half-life, better efficacy and security profile and lowest incidence of secondary effects (thrombocytopenia and osteopenia). They are administered one or two times a day and laboratory monitoring of their effect is not necessary. They are indicated in the prevention and treatment of venous thromboembolic disease and in those clinical scenarios where oral anticoagulants are contraindicated. Several LMWHs are currently used in Mexico: enoxaparin, dalteparin, tinzaparin, and nadroparin. Fondaparinux, also called pentasaccharide, is a smallest drug than LMWHs. As compared with LMWHs, it has a better pharmacokinetic and half-life profile and a more regular clinical effect however, the hemorrhagic risk associated with its use is higher. It is used a t a dose of 2.5 mg/24 hours.

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