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G Ital Cardiol (Rome). 2016 Sep;17(9 Suppl 1):29S-67. doi: 10.1714/2450.25668.

[ANMCO position paper: Use of new oral anticoagulants for the treatment and prevention of pulmonary thromboembolism].

[Article in Italian]

Author information

1
U.O.C. Medicina d'Urgenza, A.O.R.N. S. Anna e S. Sebastiano, Caserta.
2
U.O.C. Cardiologia, Ospedale S. Maria della Misericordia, Rovigo.
3
U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania.
4
Servizio di Cardiologia, Ospedale San Carlo di Nancy, Roma.
5
Medicina Interna e Vascolare, Azienda Ospedaliera di Perugia, Perugia.
6
U.O.C. Cardiologia, Ospedale San Carlo Borromeo, Milano.
7
Fondazione Moscati, Buccinasco (MI).
8
U.O. Cardiologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia.
9
U.O.C. Cardiologia Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico, Bari.
10
U.O.C. Cardiologia, Ospedale Ca' Foncello, Treviso.
11
UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro.
12
U.O.C. Cardiologia-UTIC, Ospedale Umberto I, Siracusa.
13
U.O. Nefrologia e Dialisi, IRCCS Fondazione Salvatore Maugeri, Università degli Studi, Pavia.
14
Cardiologia Interventistica-UTIC, A.O. G. Rummo, Benevento.
15
S.O.C. Cardiologia, Ospedale Castelli, Verbania.
16
Medicina Interna e Vascolare, Ospedale S. Maria della Misericordia, Università degli Studi, Perugia.

Abstract

The new oral anticoagulants (NOACs) have radically changed the approach to the treatment and prevention of thromboembolic pulmonary embolism. The authors of this position paper face, in succession, issues concerning NOACs, including 1) their mechanism of action, pharmacodynamics and pharmacokinetics; 2) the use in the acute phase with the "double drug single dose" approach or with "single drug double dose"; 3) the use in the extended phase with demonstrated efficacy and with low incidence of bleeding events; 4) the encouraging use of NOACs in particular subgroups of patients such as those with cancer, the ones under- or overweight, with renal insufficiency (creatinine clearance >30 ml/min), the elderly (>75 years); 5) they propose a possible laboratory clinical pathway for follow-up; 6) carry out an examination on the main drug interactions, their potential bleeding risk, and the way to deal with some bleeding complications. The authors conclude that the use of NOACs both in the acute phase and in the extended phase is equally effective to conventional therapy and associated with fewer major bleeding events, which make their use in patients at higher risk of recurrences safer.

PMID:
27869892
DOI:
10.1714/2450.25668
[Indexed for MEDLINE]

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