The debate on the new oral anticoagulants or NACOS

Written by: Dr. Jesús Alcaraz Rubio
Edited by: Top Doctors®

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.

*Translated with Google translator. We apologize for any imperfection

By Dr. Jesús Alcaraz Rubio

Dr. Alcaraz Rubio is a recognized specialist in Hematology with years of experience in the profession. It is optional in the Hematology and Hemotherapy area of ​​various hospitals and medical centers. In addition, he has taken doctoral courses and obtained the investigative sufficiency. He is an expert in anemia, chronic lymphatic leukemia, Hodgkin's disease, regenerative medicine and coagulation disorders. He is member of the Spanish group of Aggressive Lymphomas and hematopoietic therapy GELTAMO. On the other hand, he is the author of many national and international articles on the use of platelet and plasma growth factors. He is a member of the Spanish Society of Hematology and the American Society of Hematology. He is a member of the Spanish society of thrombosis and hemostasis. He is also a member of scientific review committees, as well as the editorial team of prestigious journals in the specialty. He is the author of the book "Regenerative Medicine and the secret of Plasma rich in Plaquetas", of the Spanish academic publishing house. He combines his work with teaching, being tutor of practices of students of 3rd year of Medicine in the subject of general pathology of the Catholic University of Murcia, as well as co-director of various courses related to the specialty for residents and specialists specialists and coordinator of The Hematologiasite platform for the development and dissemination of hematology worldwide through Wordpress.

*Translated with Google translator. We apologize for any imperfection

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