Direktni oralni antikoagulansi u stomatološkoj praksi

master's thesis

• Title (english): Direct oral anticoagulant drugs in dental clinical practice
• Author: Jurica Nekić
• Mentor: Petar Gaćina (mentor)
• Committee member: Petar Gaćina (predsjednik povjerenstva)
• Committee member: Gorana Mirošević (član povjerenstva)
• Committee member: Ivana Šutej (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Chair of Internal Medicine); Zagreb
• Defense date and country: 2022-07-08, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine

Abstract

Direktni oralni antikoagulantni lijekovi relativno su novi lijekovi na tržištu. Indicirani su za
liječenje i prevenciju nekih kardiovaskularnih i cerebrovaskularnih bolesti. Na tržištu su
trenutno dostupna 4 DOAK-a, a to su: dabigatran (Pradaxa®), rivaroksaban (Xarelto®),
apiksaban (Eliquis®) i edoksaban (Lixiana®). Dabigatran je direktni blokator trombina, a
rivaroksaban, apiksaban i edoksaban direktni su blokatori FXa. U ovom trenutku ne postoje
specifični testovi za određivanje djelotvornosti ovih lijekova, kao što je slučaj u bolesnika
liječenih antagonistima vitamina K. Zbog svojih poboljšanih svojstava i jednostavnijeg
korištenja, DOAC-i se sve više primjenjuju. Trenutno ima relativno malo podataka o ovim
lijekovima u stomatološkoj praksi, što često dovodi do nejasnoća u postupanju prema tim
bolesnicima. Konsenzus u literaturi je takav da se terapija DOAC-ima u većini slučajeva ne
prekida jer prekid terapije povećava rizik od tromboembolijskog incidenta i od većeg je
značaja u odnosu na krvarenje koje se u pravilu rješava mjerama lokalne hemostaze. U
bolesnika koji trebaju biti podvrgnuti ekstenzivnijim zahvatima i onih koji imaju neko
pridruţeno stanje koje ih svrstava u skupinu povećanog rizika za krvarenje, terapija može biti
prekinuta uz konzultaciju s nadležnim liječnikom.

Abstract (english)

The direct oral anticoagulant medicaments (later found as DOAC`s) are a relatively novel
concept on the current medical market. Their administration is intended for both treatment,
and prevention of certain cardiovascular and cerebrovascular diseases. As of now, there are
four prevalent medicaments: dabigatran (Pradaxa®), rivaroxaban (Xarelto®), apixaban
(Eliquis®), and edoxaban (Lixiana®). Dabigatran is utilized as a direct inhibitor of thrombin,
while the rest of the listed substances are applied as FXa inhibitors. At this particular moment
in time there are no specific tests that would precisely define the coagulation status with
patients who actively use these drugs, unlike with patients that were prescribed a vitamin K
antagonists. Due to their improved properties and ease of use, DOAC’s are being prescribed
more and more. We currently have relatively little data on these drugs in dental practice and
this often leads to ambiguities in the treatment of these patients. The consensus in the
literature is that DOAC therapy is not discontinued in most cases, as discontinuation of
therapy increases the risk of thromboembolic events and is of greater importance in relation to
bleeding, which is usually resolved by local hemostasis measures. With patients who are in
need of a more comprehensive medical procedure, or with patients who have underlying
conditions that may lead to severe hemorrhaging, the therapy may be terminated after
consulting with the supervising physician.

• Keywords: antikoagulansi; krvarenje; stomatologija; hemostaza
• Keywords (english): anticoagulants; hemorrhage; dentistry; hemostasis
• Language: croatian
• URN:NBN: urn:nbn:hr:127:781795
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-10-10 10:35:17