Abstract
Since 2008, internationally recognized guidelines have been in effect regarding the prevention and treatment of thromboembolic disease (TED). The national guidelines dealing with numerous aspects of thromboembolic disease are then based on these 8th ACCP Guidelines.
However, new drugs, particularly in the prevention of TED, have been registered since the latest issue that alter the previous therapeutic practices. The development of new effective anticoagulant drugs has focused on direct thrombin inhibitors and direct factor Xa inhibitors.
From the former group, dabigatran has been approved for clinical use, i.e. for the prevention of thromboembolic events in orthopaedics; from the latter group, rivaroxaban has been approved and apixaban is about to be registered in the Czech Republic. The other molecules have so far been in the phase of clinical testing (e. g. betrixaban, edoxaban, otamixaban).
The results of studies conducted so far are very promising; for instance, when compared to low-molecular-weight heparins, rivaroxaban was twice as effective as enoxaparin in the prophylaxis of thromboembolic events in major joint surgery; both dabigatran and rivaroxaban were more effective in preventing stroke in patients with atrial fibrillation when compared to warfarin. Importantly, these are oral agents with targeted action, blocking the individual factors of the coagulation cascade, i. e. factor Xa (xabans) and factor II (gatrans).
Low-molecular-weight heparins remain the mainstay of treatment of thromboembolic disease, with the benefit of having the possibility to be administered as a once-daily regimen, in both outpatient and inpatient care (Clexane Forte, Fraxiparine Forte, Zibor injections)