The debate on the new oral anticoagulants or NACOS
Written by:Traditionally anticoagulants have been used to treat venous thromboembolism and preventing stroke in patients with atrial fibrillation. However, the consequences with other drugs, food or alcohol have led to the emergence of new oral anticoagulants or NACOS.
What are the new oral anticoagulants and what are its uses
New, better known as NACOS, oral anticoagulants are controversial even among the specialists themselves in Hematology and anticoagulation.
For many years, oral anticoagulant in the prevention and treatment of venous thromboembolism have been carried out by drugs antagonists of vitamin K (AVK). Such drugs have also been used for the prevention of stroke in patients with atrial fibrillation (the most common type of arrhythmia), in the prevention of thromboembolism in patients with mechanical heart valves and other indications. In fact, it is estimated that in Spain, 14 of every 1,000 inhabitants receive, per year, this type of treatment.
According to experts in hematology , this type of therapy makes strict control required to achieve reasonable levels of safety in anticoagulation, as the interaction with other drugs or food or alcohol had consequences. However, and because of that, we have investigated the appearance of new molecules with increased therapeutic index, low variability between patients and within the same patient. Thus allow the administration of a fixed dose without such a close monitoring of the patient.
For these reasons were called NACOS drugs, which have a specific target on the blood coagulation cascade; in particular, the factors II (thrombin) and coagulation factor X, which makes its action is more physiological anticoagulant.
Why new blood thinners or have not displaced NACOS conventional
Although these drugs are certainly the future of anticoagulant therapy, more randomized clinical trials are still needed to establish the correct indication thereof.
Experts have doubts as to how and when to perform analytical control of anticoagulated patients, especially in situations of thrombotic or hemorrhagic risk:- Invasive procedures or surgery- Neuraxial anesthesia- Thrombolysis in case of stroke or myocardial
In addition, these are liable to NACOS pharmacokinetic interactions with certain types of antibiotics, anticonvulsants or anti-arrhythmic, and have varying degrees of renal clearance ranging between 80% and 20%. This could increase the risk of bleeding events in patients with renal insufficiency.
The absence of a fully effective treatment creates some uncertainty, especially there is limited experience in the treatment of bleeding complications.
