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Trombofilia & rerapĂȘutica anticoagulante oral
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Abstract(s)
A trombofilia Ă© uma condição hereditĂĄria e/ou adquirida na qual uma anomalia da hemĂłstase aumenta o risco de trombose, levando Ă formação de trombos vasculares venosos e/ou arteriais. As trombofilias hereditĂĄrias comumente aceites sĂŁo a variante do Fator V de Leiden, a variante do gene da protrombina (G20210A), deficiĂȘncia de proteĂna C, deficiĂȘncia de proteĂna S e deficiĂȘncia de antitrombina. As trombofilias adquiridas mais relevantes incluem a sĂndrome antifosfolĂpidica, hemoglobinĂșria paroxĂstica noturna, neoplasias mieloproliferativas e a presença de uma mutação JAK2 na ausĂȘncia de um fenĂłtipo de neoplasias mieloproliferativas. As manifestaçÔes clĂnicas compreendem o tromboembolismo venoso (trombose venosa profunda e embolia pulmonar), abortos recorrentes e complicaçÔes obstĂ©tricas, e tromboses menos comuns tais como trombose venosa cerebral, trombose venosa esplĂąncnica, e o acidente vascular cerebral e acidente isquĂ©mico transitĂłrio. Os eventos trombĂłticos sĂŁo uma causa significativa de mortalidade e morbilidade no mundo ocidental.
Com uma multiplicidade de novas abordagens farmacolĂłgicas surgindo ao nĂvel da terapĂȘutica antitrombĂłtica, os anticoagulantes orais diretos (dabigatrano, rivaroxabano, apixabano e edoxabano) podem oferecer mais vantagens relativamente aos antivitamĂnicos K (varfarina e acenocumarol) no tratamento e prevenção das doenças tromboembĂłlicas, tendo resultados comparĂĄveis ou melhores ao nĂvel da eficĂĄcia e segurança. No entanto, a evidĂȘncia Ă© escassa no que diz respeito ao uso de anticoagulantes orais diretos em trombofilias hereditĂĄrias ou adquiridas. Assim, a varfarina, um fĂĄrmaco com 70 anos de experiĂȘncia e apesar das desvantagens ao nĂvel da monitorização e segurança, permanece o gold standard da terapĂȘutica anticoagulante oral na prevenção secundĂĄria de eventos tromboembĂłlicos na trombofilia.
O farmacĂȘutico desempenha um papel primordial para garantir a adesĂŁo Ă terapĂȘutica e o uso racional da terapĂȘutica anticoagulante oral.
Thrombophilia is a condition either acquired or inherited in which an anomaly in the hemostasis enhances the risk of thrombosis, leading to the formation of both vascular and arterial clots. Inherited thrombophilia most commonly accepted are the variant on the factor V of Leiden, variant on protrombin gene (G20210A), protein C deficiency, protein S deficiency and deficiency of antithrombin. Whereas the most relevant amongst the thrombophilias acquired include antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria, myeloproliferative neoplasms, and the presence of a JAK2 mutation in the absence of a myeloproliferative neoplasms phenotype. Clinical manifestations include venous thromboembolism (deep vein thrombosis and pulmonary embolism), recurring miscarriage and obstetrics complications, and less common thrombosis such as cerebral venous thrombosis, splanchnic venous thrombosis, and stroke and transient ischemic accident. Thrombotic events are a significant cause of both mortality and morbidity throughout the western world. With an upcoming multitudinous of new pharmaceutical approaches in terms of the antithrombotic therapy, the direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) can provide more advantages in comparison to vitamin K antagonists (warfarin and acenocoumarol) in both treatment and prevention of thromboembolic diseases, delivering similar or even heightened efficiency and security results. However, the evidence of direct oral anticoagulants on inherited and acquired thrombophilias is limited. Thus, warfarin, a drug known up for 70 years, and despite its disadvantages in terms of monitoring and safety, remains the gold standard of oral anticoagulant therapy in the secondary prevention of thromboembolic events in thrombophilia. Pharmacists undertake a key role in guaranteeing not only the adherence to the therapy but the rational use of the oral anticoagulant therapy as well.
Thrombophilia is a condition either acquired or inherited in which an anomaly in the hemostasis enhances the risk of thrombosis, leading to the formation of both vascular and arterial clots. Inherited thrombophilia most commonly accepted are the variant on the factor V of Leiden, variant on protrombin gene (G20210A), protein C deficiency, protein S deficiency and deficiency of antithrombin. Whereas the most relevant amongst the thrombophilias acquired include antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria, myeloproliferative neoplasms, and the presence of a JAK2 mutation in the absence of a myeloproliferative neoplasms phenotype. Clinical manifestations include venous thromboembolism (deep vein thrombosis and pulmonary embolism), recurring miscarriage and obstetrics complications, and less common thrombosis such as cerebral venous thrombosis, splanchnic venous thrombosis, and stroke and transient ischemic accident. Thrombotic events are a significant cause of both mortality and morbidity throughout the western world. With an upcoming multitudinous of new pharmaceutical approaches in terms of the antithrombotic therapy, the direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) can provide more advantages in comparison to vitamin K antagonists (warfarin and acenocoumarol) in both treatment and prevention of thromboembolic diseases, delivering similar or even heightened efficiency and security results. However, the evidence of direct oral anticoagulants on inherited and acquired thrombophilias is limited. Thus, warfarin, a drug known up for 70 years, and despite its disadvantages in terms of monitoring and safety, remains the gold standard of oral anticoagulant therapy in the secondary prevention of thromboembolic events in thrombophilia. Pharmacists undertake a key role in guaranteeing not only the adherence to the therapy but the rational use of the oral anticoagulant therapy as well.
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Keywords
Anticoagulação oral Anticoagulantes orais diretos Antagonistas da vitamina k Trombofilia