Journal of Literature Pharmacy Sciences

Atriyal Fibrilasyon ve İlişkili Risk Gruplarında Direkt Oral Antikoagülanların Kullanımı: Geleneksel Derleme
The Use of Direct Oral Anticoagulants in Atrial Fibrilation and Related Risk Groups: A Traditional Review
Yunus Emre AYHANa, Duygu ÜNDERa, Enes Emir İLERLERa, İpek MİDİb, Mesut SANCARa
aMarmara Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık ABD, İstanbul, Türkiye
bMarmara Üniversitesi Tıp Fakültesi, Nöroloji ABD, İstanbul, Türkiye
J Lit Pharm Sci. 2023;12(1):72-81
doi: 10.5336/pharmsci.2022-92554
Article Language: TR
Full Text
ÖZET
 Atriyal fibrilasyonu (AF) olan hastalarda tromboembolik olay riskini azaltmak için oral antikoagülanların rolü çok önemlidir. Bu amaçla, yaygın olarak kullanılan antikoagülan ilaç bir K vitamini antagonisti [vitamin K antagonist (VKA)] olan varfarindir. Fakat nonvalvüler AF'li hastalarda, diğer ilaçlarla minimum düzeyde etkileşime girmesi, gıda ile etkileşimlerinin olmaması ve antikoagülan aktivitelerinin sık izlem gerektirmemesi gibi özellikleri, direkt oral antikoagülanları (DOAK) etkinliği ve güvenliği açısından ön plana çıkarmıştır. Son yıllarda klinik çalışmalardan ve gerçek yaşam kanıtlarından veriler elde edildikçe, DOAK'lerin kullanım endikasyonları artmakta ve birçok bağlamda güvenli ve etkili bir terapötik yaklaşım olarak VKA tedavisinin yerini almaktadır. Çalışmalardan elde edilen kapsamlı sonuçlara göre DOAK'ler VKA'ya kıyasla inme, sistemik emboli ve intrakraniyal kanama vakalarında önemli bir azalma sağlamıştır. DOAK'lerin VKA tedavisine göre bazı avantajları olmasına rağmen etkinlik ve güvenliği sağlamak için tedavide DOAK'ler ve VKA arasındaki tercih aşamasında dikkatli bir karar verme süreci gerekmektedir. AF'si olan ve aynı zamanda farklı komorbiditelere sahip riskli hastalarda DOAK'lerin kullanımıyla ilgili olarak net veriler bulunmamaktadır. Bu derlemede, AF'si olan, perkütan koroner girişim uygulanan, yaşlı, obez, kronik böbrek yetersizliği, karaciğer yetersizliği, siroz hastalığı, kırık riski ve kalp kapak hastalığı olan hastalarda DOAK'lerin kullanımına dair sistematik derleme ve metaanalizlerin sonuçları sunulmuştur. Sonuç olarak, AF'li hastalarda belirtilen komorbidite durumlarında DOAK'leri VKA'ya karşın ön plana çıkaran kanıtlar mevcut olsa da daha fazla çalışmaya ve güçlü kanıtlara ihtiyaç duyulduğu belirtilmektedir.

Anahtar Kelimeler: Atriyal fibrilasyon; iskemik inme; antikoagülanlar; kanama
ABSTRACT
 The role of oral anticoagulants is significant in reducing the risk of thromboembolic events in patients with atrial fibrillation (AF). The anticoagulant drug commonly used for this purpose is warfarin, a vitamin K antagonist (VKA). However, in patients with nonvalvular AF, direct oral anticoagulants (DOAC) have come to the forefront regarding their efficacy and safety due to their minimal interaction with other drugs, no interactions with food, and the fact that their anticoagulant activities do not require frequent monitoring. In recent years, as data from clinical trials and real-life evidence become available, indications for the use of DOACs have increased and are replacing VKA therapy as a safe and effective therapeutic approach in many contexts. Comprehensive results from the studies showed that DOACs significantly reduced stroke, systemic embolism, and intracranial hemorrhage compared to VKA. Although DOACs have some advantages over VKA treatment, careful decision-making is required to choose between DOACs and VKAs in treatment to ensure efficacy and safety. There are no clear data on the use of DOACs in risky patients with AF and different comorbidities. In this review, systematic reviews and meta-analyses on DOACs in patients with AF undergoing percutaneous coronary intervention, elderly, obese, chronic renal failure, liver failure, cirrhosis, fracture risk, and valvular heart disease are presented. In conclusion, although there is evidence that favors DOACs over VKA in the comorbidities stated in patients with AF, it is stated that more studies and strong evidence are needed.

Keywords: Atrial fibrillation; ischemic stroke; anticoagulants; hemorrhage
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4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com