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Web End = J Thromb Thrombolysis (2016) 41:1531 DOI 10.1007/s11239-015-1314-3
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Web End = Pharmacology of anticoagulants used in the treatment of venous thromboembolism
Edith A. Nutescu1 Allison Burnett2 John Fanikos3 Sarah Spinler4
Ann Wittkowsky5
Published online: 16 January 2016 The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benets and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants requires not only an in-depth knowledge of their pharmacologic properties but also a comprehensive approach to patient management and education. This paper will summarize the key pharmacologic properties of the anticoagulant agents used in the treatment of patients with VTE.
Keywords Pharmacology Mechanism of action
Anticoagulants Warfarin Heparins Direct oral
anticoagulants (DOAC)
Introduction
Anticoagulant drugs are the mainstay of therapy for patients with venous thromboembolism (VTE). Specic treatment decisions are guided by balancing the risks and benets of various anticoagulants. The treatment of VTE can be divided into 3 phases: acute (rst 510 days), long-term (rst 3 months), and extended (beyond 3 months) [1]. The acute treatment phase of VTE consists of administering a rapid-onset parenteral anticoagulant [unfractionated heparin (UFH), low molecular weight heparin (LMWH), fondaparinux] or direct oral anticoagulant (DOAC; apixaban, rivaroxaban). Long-term and extended phase anticoagulation for VTE is usually accomplished using oral anticoagulant agents such as warfarin, or one of the DOACs (apixaban, dabigatran, edoxaban and rivaroxaban) [1, 2]. The optimal selection and management of anticoagulant drugs for the treatment of VTE requires not only an in-depth knowledge of the efcacy, safety and clinical outcomes data but also of the pharmacology for each agent. This paper will summarize the key pharmacologic properties of the anticoagulant agents used in the treatment of VTE.
Unfractionated heparin
UFHs are naturally-occurring glycosaminoglycans derived from porcine intestinal or bovine lung mucosal tissues [3 6]. Commercial UFH is composed of a heterogeneous group...