NEW ORAL ANTICOAGULANTS, RECENT TREND IN THE PERIOPERATIVE THERAPY

Abstract

Thromboembolic disorders are among the major causes of morbidity and mortality,all over the world including the hospitalized patients and the general population,so anticoagulation mechanisms remain the cornerstone of prevention and treatment of these disorders. For many years the main anticoagulant agents that have been used to produce proper anticoagulant effect for venous thromboembolism prophylaxis were either the parenteral agents including heparin and its derivatives or the oral anticoagulant drugs like vitamin K antagonists as warfarin. However the great success that was achieved by the use of the traditional anticoagulants over years the need for developing new agents has been raised as an attempt to overcome the limitations and the drawbacks that have been associated with the traditional anticoagulant therapy. The new agents are known as the new oral anticoagulants (NOACs) provide a reliable anticoagulant effect without the need for routine lab monitoring due to its predictable anticoagulant effect less incidence of hemorrhagic events and less food or drug interactions especially if compared to warfarin. So,understanding the pharmacological properties and medical applications of the new oral anticoagulant drugs is necessary besides the need to explore their regimen perioperatively,especially in regional anesthesia and in different medical and surgical situations. However these newly developed agents have some drawbacks; for example the lack of a specific antidote in addition to the absence of detailed information about their long term safety and effectiveness due to lack of clinical trials,besides their limitations in use with some patient groups such as patients with severe renal dysfunction and patients with mechanical heart valves