Antikoagülan ve Antiagregan İlaçların Genel Kullanım Endikasyonları
Özet
Bu bölüm, güncel kılavuzlar ve araştırmaları inceleyerek antikoagülan ve antiagregan ilaçların kullanım alanlarına ilişkin bilgileri derleyip antikoagülan ve antiagregan ilaçların hastalıkların önlenmesi ve yönetimindeki rolünü incelemeyi hedeflemektedir. Antikoagülan ilaçlar; atrial fibrilasyon, venöz tromboembolizm, konjenital hiperkoagülabilite gibi durumlarda ve mekanik kalp kapağı olan hastalarda kullanılır. Profilaktik uygulamalar, özellikle cerrahi ve travma hastalarında kritik öneme sahiptir. Antiagregan ilaçlar ise kardiyovasküler hastalıklar, inme, periferik arter hastalığı, vaskülit gibi durumların yönetiminde önemlidir. Antikoagülan ve antiagregan ilaçların etkinliği, hastaların bireysel özelliklerine göre değişiklik göstermektedir. Bu nedenle, tedavi stratejilerinin hastaların risk faktörlerine göre özelleştirilmesi gerekmektedir. Güncel iyi uygulama stratejileri ile tromboembolik olaylar belirgin azalmaktadır. İlaçların etkin ve güvenli kullanımı, tromboz ve kardiyovasküler komplikasyonların yönetiminde hayati öneme sahiptir.
This chapter aims to compile information on the use of anticoagulant and antiplatelet medications by examining current guidelines and research, and to explore their roles in the prevention and management of diseases. Anticoagulant medications are employed in conditions such as atrial fibrillation, venous thromboembolism, congenital hypercoagulability, and in patients with mechanical heart valves. Prophylactic applications are particularly critical in surgical and trauma patients. On the other hand, antiplatelet medications play a vital role in the management of cardiovascular diseases, stroke, peripheral artery disease, and vasculitis. The efficacy of both anticoagulant and antiplatelet medications varies according to individual patient characteristics; therefore, treatment strategies should be tailored based on patients' risk factors. Recent best practice strategies have led to a significant reduction in thromboembolic events. The effective and safe use of these medications is crucial in the management of thrombosis and cardiovascular complications.
Referanslar
Varlı M, Aras S. Antiagregan ve antikoagülan tedavi. Turkiye Klinikleri Geriatrics-Special Topics. 2015;1(1):29-39.
Zulkifly H, Lip GY, Lane DA. Epidemiology of atrial fibrillation. Int J Clin Pract. 2018;72(3)
Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-62.
Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet. 2021;398(10294):64-77.
Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-74.
Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-23.
Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14(7):1480-3.
Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-8.
Boutitie F, Pinede L, Schulman S, Agnelli G, Raskob G, Julian J, et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants’ data from seven trials. BMJ. 2011;342.
Couturaud F, Sanchez O, Pernod G, Mismetti P, Jego P, Duhamel E, et al. Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: the PADIS-PE randomized clinical trial. JAMA. 2015;314(1):31-40.
Couturaud F, Pernod G, Presles E, Duhamel E, Jego P, Provost K, et al. Six months versus two years of oral anticoagulation after a first episode of unprovoked deep-vein thrombosis: The PADIS-DVT randomized clinical trial. Haematologica. 2019;104(7):1493-500.
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-52.
Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis: Anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146(4):278-88.
[National Institute for Health and Clinical Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. 2018. Available from: https://www.nice.org.uk/guidance/ng89]
Wiegers HM, Middeldorp S. Contemporary best practice in the management of pulmonary embolism during pregnancy. Ther Adv Respir Dis. 2020;14:1753466620914222.
Kearsley R, Stocks G. Venous thromboembolism in pregnancy—diagnosis, management, and treatment. BJA Educ. 2021;21(3):117-123.
Sakamoto J, Yamashita Y, Morimoto T, Amano H, Takase T, Hiramori S, et al. Cancer-associated venous thromboembolism in the real world—from the COMMAND VTE registry. Circ J. 2019;83(11):2271-81.
Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166(4):458-64.
Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021 Feb 23;5(4):927-974.
Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, Coppens M, Houghton D, James AH, et al. American Society of Hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv. 2023 Nov 14;7(22):7101-7138.
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-2040.
Srinivasan A, Brown J, Krishnamani PP, Cornett B, Kesavan RB, Sarva ST, et al. Aspirin use is associated with decreased inpatient mortality in patients with COVID-19: A meta-analysis. Am Heart J Plus: Cardiol Res Pract. 2022;20:100191.
Aikins J, Koomson A, Ladele M, Al‐Nusair L, Ahmed A, Ashry A, Harky A. Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves. J Card Surg. 2020;35(12):3521-9.24. Fidancı ŞB, Yaroğlu HY, Ünal N, Güneş G, Sert GA, Sucu N, et al. Venöz tromboz ön tanısı olan hastalarda Faktör V Leiden, Protrombin G20210A, MTHFR C677T ve MTHFR A1298C mutasyonlarının dağılımı. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2010;3(3):30-34.
Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A. Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome. Cochrane Database Syst Rev. 2020;(10)
Armstrong EM, Bellone JM, Hornsby LB, Treadway S, Phillippe HM. Acquired thrombophilia. J Pharm Pract. 2014;27(3):234-42.
Einhäupl K, Bousser MG, de Bruijn SFTM, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol 2006;13:553-559.
Zhang B, Lang Y, Zhang W, Cui L, Deng F. Characteristics and management of autoimmune disease-associated cerebral venous sinus thrombosis. Front Immunol. 2021;12:671101.
Chan MY, Du X, Eccleston D, et al. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol. 2016;1(202):861-9.
Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res. 2014;114(12):1959-75.
Lopes RD. Antiplatelet agents in cardiovascular disease. J Thromb Thrombolysis. 2011;31:306-9.
Hackam DG, Spence JD. Antiplatelet therapy in ischemic stroke and transient ischemic attack: An overview of major trials and meta-analyses. Stroke. 2019;50(3):773-8.
Kamarova M, Baig S, Patel H, Monks K, Wasay M, Ali A, et al. Antiplatelet use in ischemic stroke. Ann Pharmacother. 2022;56(10):1159-73.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3)
CAPRIE Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329-39.
Prasad K, Siemieniuk R, Hao Q, Guyatt G, O’Donnell M, Lytvyn L, et al. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline. BMJ. 2018;363
Kim MS, Hwang J, Yon DK, Lee SW, Jung SY, Park S, et al. Global burden of peripheral artery disease and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health. 2023;11(10)
Golledge J. Update on the pathophysiology and medical treatment of peripheral artery disease. Nat Rev Cardiol. 2022;19(7):456-74.
Emmi G, Silvestri E, Squatrito D, Amedei A, Niccolai E, D’Elios MM, et al. Thrombosis in vasculitis: from pathogenesis to treatment. Thromb J. 2015;13:1-10.
Jeong J, Barra L. The use of anti-platelet and/or anticoagulant agents in the prevention of large vessel vasculitis-associated ischemic complications: a meta-analysis. Open J Rheumatol Autoimmun Dis. 2014;2014.
Etnel JRG, Huygens SA, Grashuis P, vd. Bioprosthetic Aortic Valve Replacement in Nonelderly Adults. Circulation: Cardiovascular Quality and Outcomes. 2019;12
Aikins J, Koomson A, Ladele M, et al. Anticoagulation and Antiplatelet Therapy in Patients with Prosthetic Heart Valves. Journal of Cardiac Surgery. 2020 Dec;35(12):3521-3529. doi: 10.1111/jocs.15034.
İnce B. İskemik inmede ikili antiagregan tedavi. Türk Beyin Damar Hastalıkları Derg. 2019;25(2):86-93.
Referanslar
Varlı M, Aras S. Antiagregan ve antikoagülan tedavi. Turkiye Klinikleri Geriatrics-Special Topics. 2015;1(1):29-39.
Zulkifly H, Lip GY, Lane DA. Epidemiology of atrial fibrillation. Int J Clin Pract. 2018;72(3)
Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-62.
Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet. 2021;398(10294):64-77.
Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-74.
Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-23.
Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14(7):1480-3.
Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-8.
Boutitie F, Pinede L, Schulman S, Agnelli G, Raskob G, Julian J, et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants’ data from seven trials. BMJ. 2011;342.
Couturaud F, Sanchez O, Pernod G, Mismetti P, Jego P, Duhamel E, et al. Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: the PADIS-PE randomized clinical trial. JAMA. 2015;314(1):31-40.
Couturaud F, Pernod G, Presles E, Duhamel E, Jego P, Provost K, et al. Six months versus two years of oral anticoagulation after a first episode of unprovoked deep-vein thrombosis: The PADIS-DVT randomized clinical trial. Haematologica. 2019;104(7):1493-500.
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-52.
Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis: Anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146(4):278-88.
[National Institute for Health and Clinical Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. 2018. Available from: https://www.nice.org.uk/guidance/ng89]
Wiegers HM, Middeldorp S. Contemporary best practice in the management of pulmonary embolism during pregnancy. Ther Adv Respir Dis. 2020;14:1753466620914222.
Kearsley R, Stocks G. Venous thromboembolism in pregnancy—diagnosis, management, and treatment. BJA Educ. 2021;21(3):117-123.
Sakamoto J, Yamashita Y, Morimoto T, Amano H, Takase T, Hiramori S, et al. Cancer-associated venous thromboembolism in the real world—from the COMMAND VTE registry. Circ J. 2019;83(11):2271-81.
Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166(4):458-64.
Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021 Feb 23;5(4):927-974.
Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, Coppens M, Houghton D, James AH, et al. American Society of Hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv. 2023 Nov 14;7(22):7101-7138.
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-2040.
Srinivasan A, Brown J, Krishnamani PP, Cornett B, Kesavan RB, Sarva ST, et al. Aspirin use is associated with decreased inpatient mortality in patients with COVID-19: A meta-analysis. Am Heart J Plus: Cardiol Res Pract. 2022;20:100191.
Aikins J, Koomson A, Ladele M, Al‐Nusair L, Ahmed A, Ashry A, Harky A. Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves. J Card Surg. 2020;35(12):3521-9.24. Fidancı ŞB, Yaroğlu HY, Ünal N, Güneş G, Sert GA, Sucu N, et al. Venöz tromboz ön tanısı olan hastalarda Faktör V Leiden, Protrombin G20210A, MTHFR C677T ve MTHFR A1298C mutasyonlarının dağılımı. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2010;3(3):30-34.
Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A. Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome. Cochrane Database Syst Rev. 2020;(10)
Armstrong EM, Bellone JM, Hornsby LB, Treadway S, Phillippe HM. Acquired thrombophilia. J Pharm Pract. 2014;27(3):234-42.
Einhäupl K, Bousser MG, de Bruijn SFTM, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol 2006;13:553-559.
Zhang B, Lang Y, Zhang W, Cui L, Deng F. Characteristics and management of autoimmune disease-associated cerebral venous sinus thrombosis. Front Immunol. 2021;12:671101.
Chan MY, Du X, Eccleston D, et al. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol. 2016;1(202):861-9.
Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res. 2014;114(12):1959-75.
Lopes RD. Antiplatelet agents in cardiovascular disease. J Thromb Thrombolysis. 2011;31:306-9.
Hackam DG, Spence JD. Antiplatelet therapy in ischemic stroke and transient ischemic attack: An overview of major trials and meta-analyses. Stroke. 2019;50(3):773-8.
Kamarova M, Baig S, Patel H, Monks K, Wasay M, Ali A, et al. Antiplatelet use in ischemic stroke. Ann Pharmacother. 2022;56(10):1159-73.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3)
CAPRIE Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329-39.
Prasad K, Siemieniuk R, Hao Q, Guyatt G, O’Donnell M, Lytvyn L, et al. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline. BMJ. 2018;363
Kim MS, Hwang J, Yon DK, Lee SW, Jung SY, Park S, et al. Global burden of peripheral artery disease and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health. 2023;11(10)
Golledge J. Update on the pathophysiology and medical treatment of peripheral artery disease. Nat Rev Cardiol. 2022;19(7):456-74.
Emmi G, Silvestri E, Squatrito D, Amedei A, Niccolai E, D’Elios MM, et al. Thrombosis in vasculitis: from pathogenesis to treatment. Thromb J. 2015;13:1-10.
Jeong J, Barra L. The use of anti-platelet and/or anticoagulant agents in the prevention of large vessel vasculitis-associated ischemic complications: a meta-analysis. Open J Rheumatol Autoimmun Dis. 2014;2014.
Etnel JRG, Huygens SA, Grashuis P, vd. Bioprosthetic Aortic Valve Replacement in Nonelderly Adults. Circulation: Cardiovascular Quality and Outcomes. 2019;12
Aikins J, Koomson A, Ladele M, et al. Anticoagulation and Antiplatelet Therapy in Patients with Prosthetic Heart Valves. Journal of Cardiac Surgery. 2020 Dec;35(12):3521-3529. doi: 10.1111/jocs.15034.
İnce B. İskemik inmede ikili antiagregan tedavi. Türk Beyin Damar Hastalıkları Derg. 2019;25(2):86-93.
