Yeni Nesil Oral Antikoagülanların Birinci Basamakta Kullanımı
Atriyal fibrilasyon (AF); inme ve felç riskini yaklaşık 5 kat arttıran bir hastalıktır. Bu nedenle bu hastalarda inme ve sistemik emboli profilaksisi oldukça önemlidir. Yakın zamana kadar uzun dönem oral antikoagülasyon tedavisi olarak vitamin K antogonisti olan varfarin kullanılmaktaydı. Ancak son zamanlarda yeni oral antikoagülanlar (YOAK); dabigatran eteksilat, rivaroksaban, apiksaban pratik kullanıma ve tedavi kılavuzlarına girmiştir. Yapılan son çalışmalara göre yeni nesil antikoagülanlar hemorajik inme ve intrakraniyal kanama riskinde anlamlı olarak azalmaya neden olmuş, majör kanama riskinde belirgin bir artışa sebep olmamıştır. Metaanalizlerin sonuçları da ana çalışmaları destekler niteliktedir, YOAK ile inme veya sistemik emboli ve hemorajik inme açısından belirgin düşüş tespit edilmiştir. Artmış intrakraniyal kanama riski olan hastalarda yeni nesil oral antikoagülanlar daha güvenli gözükürken gastrointestinal kanama riski yüksek veya böbrek fonksiyon bozukluğu olan hastalarda varfarin daha ön plana çıkmaktadır. Sonuç olarak yeni nesil oral antikoagülanları daha çok varfarin kullanamayacak veya INR dalgalanmaları olan hastalarda tercih etmeliyiz. Atriyal fibrilasyon dışında bir antikoagülasyon durumu mevcutsa (protez kapak, hiperkoagülabilite gibi) yeni oral antikoagülanların kullanımı şu aşamada kontrendikedir.
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