Features of the use of oral anticoagulants in clinical practice: focus on gastrointestinal complications

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Abstract

The review article presents dates about the physiology and pathophysiology of the hemostasis system, discusses the features of the use of oral anticoagulants in clinical practice. Oral anticoagulants are drugs characterized by predictable pharmacokinetics and pharmacodynamics, a favorable efficacy and safety profile. The article considers the main clinical and pharmacological characteristics of apixaban, rivaroxaban and dabigatran (bioavailability, metabolism, excretion); factors that increase the risk of gastrointestinal bleeding associated with anticoagulant therapy; drug interactions; the possibility of gastroprotection in patients taking oral anticoagulants. In real clinical practice, the reason for not prescribing or unreasonably reducing the dose of oral anticoagulants is the fear of bleeding. In this case, the risks of bleeding, as a rule, are overestimated. Knowledge of bleeding risk factors, prognostic scales and management of risk factors is an approach that can improve the safety of anticoagulant therapy. In clinical practice, the choice of the ideal oral anticoagulants, in addition to taking into account the risk of bleeding, should be based on a comprehensive assessment, including an assessment of the patient's age, risk of stroke and coronary events, renal function, and predicted compliance.

About the authors

Natalya V. Bakulina

North-Western State Medical University named after I.I. Mechnikov

Email: natalya.bakulina@szgmu.ru
ORCID iD: 0000-0003-4075-4096
SPIN-code: 9503-8950

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Sergey V. Tikhonov

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: sergeyvt2702@gmail.com
ORCID iD: 0000-0001-5720-3528
SPIN-code: 6921-5511

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Anna G. Apresyan

North-Western State Medical University named after I.I. Mechnikov

Email: asestr4ki@yandex.ru
ORCID iD: 0000-0003-0637-9384
SPIN-code: 8654-7705

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Inna G. Ilyashevich

North-Western State Medical University named after I.I. Mechnikov

Email: Inna.Ilyashevich@szgmu.ru
ORCID iD: 0000-0002-5784-2634
SPIN-code: 3212-7518

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

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