DOI: https://doi.org/10.22141/2224-0586.8.95.2018.155152

Anticoagulants in the treatment of pulmonary thromboembolism during the hospital period: recommendations, possibilities, approaches to rational choice. The place of fondaparinux

O.A. Koval

Abstract


The article presents the main issues of using pa­renteral anticoagulants (PAC) in the treatment of pulmonary thromboembolism (PE), which requires a combination of effectiveness and high safety, given an increase in the incidence of PE with age, as well as the need for therapy prolongation in cases of PE with cancer. The modern points of view on the mechanism of the antithrombotic action of PAC are presen­ted, the literature data on the strengthening of fibrinolytic processes by fondaparinux are discussed. These data are supported by our findings about the primary inhibition of fibrinolysis in patients with PE regardless of the risk level according to Pulmonary Embolism Severity Index, which makes fondaparinux the drug of choice among PAC for initial pulmonary embolism therapy. The advantages of low molecular weight heparins (LMWH)/fondaparinux over standard therapy with unfractionated heparin (UFH) are presented based on international and Ukrainian guidelines, the Cochrane Review. Data were analyzed from a randomized MATISS-PE study comparing UFH and fondaparinux therapy, RIETE register, confirming the high efficacy of hospital and 3-month fondaparinux the­rapy compared to UFH, LMWH and vitamin K antagonists, safety and efficacy of long-term therapy with fondaparinux on the background of cancer comparable with LMWH therapy. The need to maintain an adequate daily dosage regimen and inadequacy of 2.5 mg/day dose at any stage of therapy were emphasized.


Keywords


pulmonary embolism; anticoagulant therapy; fondaparinux

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