POSTUPNICI ZA PERIPROCEDURALNO ZBRINJAVANJE I ZBRINJAVANJE KRVARENJA U BOLESNIKA LIJEČENIH NOVIM ORALNIM ANTIKOAGULANTNIM LIJEKOVIMA

Ivan Gornik, Ingrid Prkačin, Višnja Nesek Adam, Vlatko Grabovac, Vanja Giljača, Aljoša Šikić

Cilj terapije antagonistima vitamina K (varfarin) i novim oralnim antikoagulantnim lijekovima (NOAK-ima) jesu prevencija moždanog udara i drugih embolija kod bolesnika s nevalvularnom fibrilacijom atrija te liječenje i prevencija venske tromboembolije. Kod svih bolesnika potrebno je odrediti bubrežnu funkciju klirensom kreatina jer o tome ovise izbor i doziranje NOAK-a. Izuzetno je važno obratiti pozornost na starije bolesnike s brojnim pridruženim stanjima i interakcijama lijekova zbog velike učestalosti neuroloških simptoma i lošijeg ishoda. Oralno antikoagulantno liječenje izazov je, posebno u stanjima nenamjernog predoziranja lijeka, u krvarenjima ili u stanjima hitnoga prijeoperacijskog zbrinjavanja. Zbog sve većeg broja bolesnika koji uzimaju NOAK-e osnovana je 2015. godine ekspertna grupa specijalista hitne medicine koja je u listopadu 2015. održala u Zagrebu Konsenzusnu konferenciju radi donošenja postupnika za prijeoperacijsko zbrinjavanje i zbrinjavanje bolesnika u hitnim stanjima koji uzimaju NOAK-e u Hrvatskoj.

The goal of therapy with vitamin K antagonists (warfarin), and new direct oral anticoagulant drugs (NOAC or DOAC) is the prevention of stroke and embolic events in patients with non-valvular atrial fibrillation and treatment and prevention of venous thromboembolism. In all cases it is necessary to determine renal function with creatinine clearance because it determines the choice and dosage of NOAC’s. It is extremely important to pay attention to older patients with a number of associated conditions and drug interactions, with a high incidence of neurological symptoms and worse outcomes. Oral anticoagulation can represent a challenge, especially in cases of drug overdose or emergencies such as bleeding and need for urgent surgery. The need for the guidelines has emerged during the last years because of new classes of oral anticoagulants being prescribed more frequently. The expert working group of emergency specialists was formed and gathered on Consensus Conference in October 2015 in Zagreb, to design guidelines for the patients with NOAC therapy and provides details of preoperative management and managements in emergency conditions.