Changes in the landscape of anticoagulation: a focus on direct oral anticoagulants.

IF 15.4 1区 医学 Q1 HEMATOLOGY Lancet Haematology Pub Date : 2024-10-18 DOI:10.1016/S2352-3026(24)00281-3
Walter Ageno, Bruno Caramelli, Marco Paolo Donadini, Laura Girardi, Nicoletta Riva
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Abstract

Over the last decade, the advent of direct oral anticoagulants (DOACs) has rapidly changed the landscape of anticoagulation. In the early 2010s, DOACs became widely available for stroke prevention in atrial fibrillation and the treatment of venous thromboembolism. About 10 years later, approximately two-thirds of patients requiring oral anticoagulant treatment were receiving a DOAC. The results of several post-marketing studies consistently confirmed the findings of phase 3 clinical trials, and research has focused on new areas of development, with heterogeneous results. A role for DOACs has emerged for patients with peripheral artery disease and other challenging conditions, such as cancer-associated thrombosis, unusual-site venous thromboembolism, and end-stage renal disease. Conversely, clinical trials showed that DOACs were not efficacious in patients with valvular atrial fibrillation, mechanical heart valves, embolic strokes of undetermined source, or antiphospholipid syndrome. In this Review, we discuss the impact of DOACs in clinical practice over the last decade, new areas under development, and practical issues in the management of these drugs.

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抗凝血剂领域的变化:聚焦直接口服抗凝血剂。
过去十年间,直接口服抗凝剂(DOACs)的出现迅速改变了抗凝治疗的格局。2010 年代初,DOACs 开始广泛用于预防房颤中风和治疗静脉血栓栓塞。大约 10 年后,约有三分之二需要口服抗凝剂治疗的患者正在接受 DOAC 治疗。上市后的几项研究结果一致证实了 3 期临床试验的结果,研究集中于新的开发领域,但结果各不相同。DOAC 在外周动脉疾病患者和其他具有挑战性的疾病患者中开始发挥作用,如癌症相关血栓、非正常部位静脉血栓栓塞和终末期肾病。相反,临床试验显示 DOAC 对患有瓣膜性心房颤动、机械性心脏瓣膜、来源不明的栓塞性中风或抗磷脂综合征的患者无效。在本综述中,我们将讨论 DOACs 在过去十年中对临床实践的影响、正在开发的新领域以及这些药物管理中的实际问题。
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来源期刊
Lancet Haematology
Lancet Haematology HEMATOLOGY-
CiteScore
26.00
自引率
0.80%
发文量
323
期刊介绍: Launched in autumn 2014, The Lancet Haematology is part of the Lancet specialty journals, exclusively available online. This monthly journal is committed to publishing original research that not only sheds light on haematological clinical practice but also advocates for change within the field. Aligned with the Lancet journals' tradition of high-impact research, The Lancet Haematology aspires to achieve a similar standing and reputation within its discipline. It upholds the rigorous reporting standards characteristic of all Lancet titles, ensuring a consistent commitment to quality in its contributions to the field of haematology.
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