V jakém případě se používá warfarin, NOAC a LMWH

Warfarin is used in the prophylaxis of systemic embolism in people with rheumatic heart disease and atrial fibrillation, prophylaxis after insertion of prosthetic heart valves, treatment and prophylaxis of venous thrombosis and pulmonary embolism, and transient ischaemic attacks. It requires regular INR monitoring and dose adjustments to maintain therapeutic anticoagulation.

Non-vitamin K antagonist oral anticoagulants (NOACs or DOACs), including apixaban, dabigatran, edoxaban, and rivaroxaban, are used mainly for:

• Prevention of stroke and systemic embolism in adults with non-valvular atrial fibrillation and at least one risk factor such as heart failure, hypertension, previous stroke or TIA, advanced age, or diabetes.
• Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of their recurrence.
• Prophylaxis of venous thromboembolism in adults undergoing elective hip or knee replacement surgery (apixaban, dabigatran, and rivaroxaban specifically licensed for this).
• Rivaroxaban additionally for prophylaxis of atherothrombotic events following acute coronary syndrome with elevated cardiac biomarkers, and for prevention in adults with coronary artery disease or symptomatic peripheral artery disease at high ischaemic risk, in combination with aspirin or aspirin plus clopidogrel.

DOACs do not require regular INR monitoring but require regular follow-up to assess for efficacy and adverse effects.

Low-molecular-weight heparin (LMWH) is used in the following situations:

• As initial treatment for confirmed proximal DVT or PE, especially when apixaban or rivaroxaban are unsuitable.
• For at least 5 days followed by dabigatran or edoxaban in some treatment regimens.
• Given concurrently with a vitamin K antagonist (VKA) for at least 5 days or until INR is therapeutic, followed by VKA monotherapy.
• In people with confirmed proximal DVT or PE and established renal failure (creatinine clearance less than 15 ml/min), LMWH or unfractionated heparin (UFH) is recommended.
• In people with active cancer and confirmed proximal DVT or PE, LMWH alone or with VKA is considered if DOACs are unsuitable.
• For pharmacological venous thromboembolism prophylaxis in hospitalized patients whose VTE risk outweighs bleeding risk, such as in acute psychiatric wards, LMWH is considered.