Oral Anticoagulation.
Review published in Deutsches Arzteblatt international (2018)
Abstract
BACKGROUND: Much new evidence on oral anticoagulation has come to light in recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have been developed and have been introduced into clinical practice. In this review, we present the current state of the evidence on anticoagulation for various indications with vitamin K antagonists (VKA) and with NOAC. METHODS: This review is based on pertinent articles retrieved by a selective search in PubMed (search terms: anticoagulation, atrial fibrillation, prosthetic valve, thrombosis, pulmonary embolism) and on specialty society recommendations and relevant guidelines from the years 2000-2018. RESULTS: The main indications for oral anticoagulation are atrial fibrillation, venous thromboembolism, and status post heart valve replacement. In patients with atrial fibrillation and without valvular heart disease, anticoagulation is recommended for men with a CHA2DS2-VASc score ≥ 1 and for women with a score ≥ 2. NOAC for this indication are associated with a marginally lower rate of stroke than VKA (3.5% vs. 3.8%, number needed to treat [NNT] = 333) as well as a lower rate of major hemorrhage (5.1% vs. 6.2%, NNT = 91). NOAC are contraindicated for patients with mechanical heart valves. Anticoagulation with VKA can be predictably antagonized. Among the various types of NOAC, the anticoagulant effect of dabigatran can be safely antagonized with an antidote; no specific antidote is yet available for apixaban, rivaroxaban, or edoxaban. CONCLUSION: The evidence base for anticoagulation over a time frame of several years is inadequate at present, and direct comparative data for the different types of NOAC are not yet available.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Much new evidence on oral anticoagulation has come to light in recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have been developed and have been introduced into clinical practice.
Por qué esto importa para la hirudoterapia
Esta revisión evaluó el estado actual de la evidencia sobre la anticoagulación oral, comparando específicamente los antagonistas de la vitamina K (AVK) y los anticoagulantes orales no dependientes de vitamina K (ACOD) en diversas indicaciones cardiovasculares. Para la American Society of Hirudotherapy, este artículo aporta información de fondo importante sobre las terapias anticoagulantes sistémicas, que en términos conceptuales se corresponden con los potentes efectos anticoagulantes localizados de los componentes salivales de la sanguijuela, como la hirudina. Revisar los riesgos hemorrágicos y los mecanismos terapéuticos de los anticoagulantes orales convencionales ayuda a definir el panorama clínico en el que las terapias derivadas de sanguijuela podrían comprenderse o contrastarse. Sin embargo, el resumen se centra exclusivamente en la farmacología convencional y no menciona sanguijuelas, hirudoterapia ni el secretoma de la sanguijuela, lo que representa únicamente una relevancia temática indirecta.
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026