La gestione della TAO con i nuovi farmaci anticoagulanti orali: una nuova frontiera, in Rivaroxaban per la prevenzione dell’ictus in pazienti con fibrillazione atriale: risultati di una valutazione di HTA

[Autom. eng. transl.] Although more than half a century has passed since their introduction in clinical use, the coumarins, anti-vitamin K (VKA) drugs which include warfarin and acenocoumarol, still represent the class of oral anticoagulants (AO) of reference in prevention of venous and arterial thromboembolism, in particular in patients with atrial fibrillation (AF), prosthetic valves and left ventricular thrombosis. Given their high efficacy in cardioembolic prophylaxis, however, VKAs are characterized by numerous limitations, above all because of their unpredictable pharmacokinetic and pharmacodynamic effects and the need for routine monitoring of coagulation factors, aspects which make it difficult use in clinical practice. In fact, many patients with AF or do not receive any oral anticoagulant treatment (TAO), despite the indication to perform it, or are treated but the quality of anticoagulation is often not satisfactory. In the chapter, in order to outline the benefits and limitations of VKAs in the thromboembolic prophylaxis of FA and the new perspectives of treatment with the new AO drugs, the following topics will be addressed: the main characteristics of TAO with VKA and of patients in treatment; the procedures for managing patients in TAO with VKA; the organizational context and the Surveillance Centers of the TAO; new AO drugs for stroke prevention in patients with FANV.