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Trois nouveaux anticoagulants disponibles en 2011: Dabigatran Etexilate, Rivaroxaban et Apixaban

Three new oral anticoagulants Rivaroxaban, Apixaban, Dabigatran Etexilate

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Résumé

Les antagonistes de la vitamine K (AVK) et les héparines sont les thérapeutiques de référence de la prévention des accidents thromboemboliques veineux et artériels. Ils ont de nombreux avantages et un petit nombre d’inconvénients: iatrogénicité et nécessité d’une surveillance biologique pour les AVK, activité limitée à la voie parentérale pour les héparines.

Trois nouveaux anticoagulants oraux, inhibiteurs directs du facteur Xa (le Rivaroxaban, l’Apixaban) ou du facteur IIa ou thrombine (le Dabigatran etexilate) ont été enregistrés.

Ils ne nécessitent pas de surveillance de la coagulation. Le régime alimentaire n’influence pas l’activité de ces 3 nouvelles molécules. Un petit nombre de médicaments peut modifier leur activité anticoagulante. La thromboprophylaxie en clinique orthopédique majeure et la fibrillation atriale non valvulaire sont des indications reconnues par les autorités de santé.

Leur utilisation dans le traitement des accidents thromboemboliques veineux et la prévention secondaire n’est pas encore validée par les autorités de santé. L’information du médecin et l’éducation du patient sont vivement recommandées pour aider au succès de cette révolution thérapeutique.

Abstract

Vitamin K antagonists (VKA) and heparins are the commonly used therapeutics in the prevention of venous and arterial thromboembolic episodes. They have numerous advantages and few flaws: iatrogenicity and compulsory biological monitoring for the VKA, and activity limited to the parenteral way for heparins.

Three new oral anticoagulants, direct inhibitors of factor Xa (Rivaroxaban, Apixaban) or of factor IIa or thrombin (Dabigatran Etexilate), do not need coagulation monitoring. The diet does not influence the activity of these 3 new molecules. A small number of drugs can modify their anticoagulant activity. The thromboprophylaxis in major orthopedic surgery and the non valvular atrial fibrillation are registered by the Health Authorities. Their use in the treatment of venous thromboembolic episodes and the prevention of recurrence or secondary prevention has not been yet validated by the Health Authorities.

The physician’s information and the patient’s education are strongly recommended for the success of this therapeutic revolution.

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Références

  1. Paikin JS, Eikelboom JW, Cairns JA, Hirsh J (2010) New antithrombotic agents-insights from clinical trials. Nat Rev Cardiol 7: 498–509

    Article  PubMed  CAS  Google Scholar 

  2. Douketis JD (2010) Pharmacologic properties of the new oral anti — coagulants: A clinician oriented review with a focus on perioperative management. Current Pharmaceutical Design 16: 3436–3441

    Article  PubMed  CAS  Google Scholar 

  3. Mehta RS (2010) Novel oral anticoagulants for prophylaxis and treatment of venous thromboembolism: part I (factor Xa inhibitors). Expert Rev Hematol 3: 227–241

    Article  PubMed  CAS  Google Scholar 

  4. Mehta RS (2010) Novel oral anticoagulant part II: direct thrombin inhibitors. Expert Rev Hematol 3: 351–361

    Article  PubMed  CAS  Google Scholar 

  5. Samama M, Conard J, Horellou M.-H, et al. (2010) Deux nouveaux anticoagulants disponibles en 2010 — Dabigatran Etexilate et Rivaroxaban: progrès attendus — problèmes posés. Ann Pharm Fra 68: 359–369

    CAS  Google Scholar 

  6. Samama MM, Gerotziafas GT (2010) Newer anticoagulants in 2009. J Thromb Thrombolysis 29: 92–104

    Article  PubMed  CAS  Google Scholar 

  7. Eriksson BI, et al. for the RE-NOVATE Study Group (2007) Dabigatran etexilate versus enoxaparine for the prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, noninferiority trial. Lancet 370: 949–956

    Article  PubMed  CAS  Google Scholar 

  8. Eriksson BI, Dahl OE, Huo MH, et al. for the RE-NOVATE II Study Group (2011) Oral dabigatran versus enoxaparin for the thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II). Thromb Haemost 105: 721–729

    Article  PubMed  CAS  Google Scholar 

  9. Eriksson BI, et al. for the RE-MODEL Study Group (2007) Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomised trial. J Thromb Hemost 5: 2178–2185

    Article  CAS  Google Scholar 

  10. Ginsberg JS, fet al. for the RE-MOBILIZE Writing Committee (2009) Oral thrombin inhibitor dabigatran etexilate vs North America enoxaparin regimen for the prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplasty 24: 1–9

    PubMed  Google Scholar 

  11. Eriksson BI, Borris LC, Friedman RJ, et al. RECORD-I Study Group (2008) Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 358: 2765–2775

    Article  PubMed  CAS  Google Scholar 

  12. Kakkar AK, Brenner B, Dahl OE, et al. RECORD-2 Investigators (2008) Extended duration rivaroxaban versus short term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double blind, randomised controlled trial. Lancet 372: 31–39

    Article  PubMed  CAS  Google Scholar 

  13. Lassen MR, Agneo W, Borris LC, et al. RECORD-3 Investigators (2008) Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 358: 2776–2786

    Article  PubMed  CAS  Google Scholar 

  14. Turpie AG, Lassen MR, Davidson Bl, et al. RECORD-4 Investigators (2009) Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty: a randomised trial. Lancet 373: 1673–1680

    Article  PubMed  CAS  Google Scholar 

  15. Lassen MR, Raskob GE, Gallus A, et al. ADVANCE-2 Investigators (2010) Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet 375: 807–815

    Article  PubMed  CAS  Google Scholar 

  16. Lassen MR, Gallus A, Raskob GE, et al. ADVANCE-3 Investigators (2010) Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 363: 2487–2498

    Article  PubMed  CAS  Google Scholar 

  17. Schulman S, Kearon C, Kakkar AK, et al. RE-COVER Study group (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361: 2342–2352

    Article  PubMed  CAS  Google Scholar 

  18. Buller HR, Lensing AW, Prins MH, et al. EINSTEIN-DVT Dose-Ranging Study Investigators (2008) A dose ranging study evaluating once daily oral administration of the factor Xa inhibitor rivaroxaban in the treatment of patients with acute symptomatic deep vein thrombosis: the Einstein-DVT Dose-Ranging Study. Blood 112: 2242–2247

    Article  PubMed  CAS  Google Scholar 

  19. Connolly SJ, et al. for the RE-LY Steering Committee and Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361: 1139–1151

    Article  PubMed  CAS  Google Scholar 

  20. Gage BF. Can we rely on RE-LY? (2009) N Engl J Med 361:1200–1202

    Article  PubMed  CAS  Google Scholar 

  21. Viles-Gonzalez JF, Fuster V, Halperin JL (2011) New anticoagulants for prevention of stroke in patients with atrial fibrillation. J Cardiovasc Electrophysiol June 10 [Epub ahead of print]

  22. ROCKET AF Study Investigators (2010) Rivaroxaban-once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation: rationale and design of the ROCKET AF study. Am Heart J 159: 340–347

    Article  Google Scholar 

  23. Connolly SJ, Eikelboom J, Joyner C, Diener HC, et al. AVERROES Steering Committee and Investigators (2011) Apixaban in patients with atrial fibrillation (AVERROES study). N Engl J Med 364: 806–817

    Article  PubMed  CAS  Google Scholar 

  24. Lynch DR (2011) Letter to the Editor on Apixaban in patients with atrial fibrillation. N Engl J Med 364: 2362–2363

    Article  PubMed  CAS  Google Scholar 

  25. Lopes RD, Alexander JH, Al-Khatib SM, et al. ARISTOTLE Investigators (2010) Apixaban for Reduction In STroke and Other ThromboemboLic Events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J 159: 331–339

    Article  PubMed  CAS  Google Scholar 

  26. Gibson CM, Mega JL, Barton P, et al. (2011) Rationale and design of the Anti-Xa Therapy to Lower cardiovascular events in Addition to standard therapy in Subjects with acute coronary syndrome-thrombolysis in myocardial infarction 51 (ATLAS-ACS 2 TIMI 51) trial: A randomized, doubleblind, placebo-controlled study to evaluate the efficacy and safety of rivaroxaban in subjects with acute coronary syndrome. Am Heart J 161: 815–821

    Article  PubMed  CAS  Google Scholar 

  27. APPRAISE Steering Committee and Investigators. Alexander JH, Becker RD, Bhatt DL, et al. (2009) Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the APixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial. Circulation 119: 2877–2885

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hôtel-Dieu, Groupe hospitalier Broca-Cochin, Paris, France

    M. M. Samama

  2. Laboratoire Biomnis, Ivry-sur-Seine, France

    M. M. Samama

  3. Hôpital Tenon, Paris, France

    G. Gerotziafas

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  2. G. Gerotziafas
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Correspondence to M. M. Samama.

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Samama, M.M., Gerotziafas, G. Trois nouveaux anticoagulants disponibles en 2011: Dabigatran Etexilate, Rivaroxaban et Apixaban . Bio trib. mag. 38, 10–15 (2011). https://doi.org/10.1007/s11834-011-0048-6

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