Efectividad y Seguridad de nuevos anticoagulantes orales utilizados para la prevención del accidente cerebrovascular isquémico en pacientes diagnosticados con fibrilación atrial no valvular

Fiorella Betrano
Estudiante de internado en Farmacia, Universidad de Costa Rica.
Costa Rica.

Dr. José Miguel Chaverri Fernández
Profesor asociado del Departamento de Farmacología, Toxicología y Farmacodependencia de la Facultad de Farmacia de la Universidad de Costa Rica y farmacéutico del Hospital Clínica Bíblica.
Miembro del Colegio de Farmacéuticos de Costa Rica.
Costa Rica.

Kimberlyn Miranda
Estudiante de internado en Farmacia, Universidad de Costa Rica.
Costa Rica.

Dra. Angie Ortíz Ureña
Profesora del Departamento de Farmacología, Toxicología y Farmacodependencia de la Facultad de Farmacia de la Universidad de Costa Rica.
Miembro del Colegio de Farmacéuticos de Costa Rica.
Costa Rica.

Alma Rivera
Estudiante de internado en Farmacia, Universidad de Costa Rica.
Costa Rica.

Dr. Esteban Zavaleta Monestel
Director de la Farmacia Hospital Clínica Bíblica, Costa Rica.
Miembro del Colegio de Farmacéuticos de Costa Rica.
Costa Rica.

Resumen

Los accidentes cerebrovasculares (ACV) generan gran cantidad de muertes y discapacidades a nivel mundial, y una de sus principales causas es la fibrilación atrial no valvular. Actualmente se cuenta con terapias tradicionales como la aspirina, ya sea sola o en combinación con clopidogrel y warfarina, las cuales han demostrado ser efectivas; pero presentan diversas limitantes, razón por la cual se han desarrollado nuevas alternativas que buscan eliminar y reducir dicha problemática y mejorar su efectividad. Estos medicamentos son conocidos como “nuevos anticoagulantes orales” (NOACs, por sus siglas en inglés) y se clasifican en dos grupos: los inhibidores directos de la trombina (dabigatrán) y los inhibidores del factor X activado (edoxabán, rivaroxabán y apixabán).

Si bien con el análisis de los estudios clínicos respectivos para cada uno de los NOACs se obtienen ciertas conclusiones, no es posible establecer cuál es el anticoagulante ideal; por tanto, el presente estudio busca suministrar al tratante herramientas que le permitan tomar una decisión, basada en la evidencia, con respecto a posibles diferencias, beneficios y perjuicios que se podrían suscitar, ya sea con el estándar (warfarina) o con los otros NOACs, esto ante la ausencia de estudios clínicos que comparen dichos medicamentos entre sí

Palabras claves

Accidente cerebrovascular, anticoagulantes orales, fibrilación atrial no valvular, warfarina.

Abstract

Stroke generates a large number of deaths and disabilities worldwide; one of its main causes being nonvalvular atrial fibrillation. Current traditional therapies such as aspirin, either alone or in combination with clopidogrel, and warfarin, have proved to be effective for prevention of ischemic stroke; nevertheless, these medications have several limitations. New alternatives that strive not only to eliminate or reduce these limitations but to improve their effectiveness as prophylactic treatment of ischemic stroke in patients with non-valvular atrial fibrillation have been developed. These drugs are known as “new oral anticoagulants” (NOACs) and are classified into two groups: direct thrombin inhibitors (dabigatrán) and factor Xa inhibitors (edoxabán, rivaroxabán and apixabán).

Certain conclusions could be obtained with the analysis of the respective clinical studies for each NOAC. We have dedicated this literature review to analyze the different clinical evidence regarding NOACs for stroke prevention. This work would bring tools for physicians, based on published clinical evidence regarding possible differences, benefits and damages that could arise, either from standard medication (warfarin) or other NOACs, all of this in the absence of clinical studies comparing these drugs and its effects.

Keywords

Stroke, oral anticoagulants, non-valvular atrial fibrillation, warfarin .

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