直接作用口服抗凝剂使用中尚未解决的问题。

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-12-13 DOI:10.1080/14779072.2023.2271388
Noel Chan, Jack Hirsh
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引用次数: 0

摘要

简介:目前批准的直接口服抗凝剂(DOAC)靶向凝血酶或凝血因子Xa。DOAC在没有常规实验室监测的情况下以固定剂量给药,简化了口服抗凝的方法,而以前的选择仅限于维生素K拮抗剂(VKAs)。涵盖的领域:我们讨论了a)与DOAC的最佳使用相关的未解决问题,以及b)新的发展,包括FXIa抑制剂成为有效和更安全的抗凝剂的潜力。专家意见:通过简化口服抗凝,DOAC促进了抗凝的吸收。DOAC被批准用于预防心房颤动的中风以及预防和治疗静脉血栓栓塞,其适应症正在扩大,包括预防动脉粥样硬化血栓形成。DOAC现在已经取代了维生素K拮抗剂(VKAs),用于大多数适应症,但不是所有适应症。对于患有机械心脏瓣膜、左心室辅助装置、风湿性心房颤动和抗磷脂综合征的患者,DOAC不如VKAs,并且在某些人群中(如晚期肾病和肝病),其安全性和有效性尚不确定。使用的障碍包括出血和成本问题。新开发的FXIa和FXIIa抑制剂有可能比目前的抗凝剂更安全,但需要进行3期试验来确认其临床疗效和安全性。
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Unresolved issues in the use of direct acting oral anticoagulants.

Introduction: Currently approved direct oral anticoagulants (DOACs) target thrombin or coagulation factor Xa. Administered in fixed doses without routine laboratory monitoring, DOACs have simplified the approach to oral anticoagulation, when previously the choice was limited to vitamin K antagonists (VKAs).

Area covered: We discuss a) unresolved issues related to optimal use of DOACs and b) new developments including the potential for FXIa inhibitors to be effective and safer anticoagulants.

Expert opinion: By simplifying oral anticoagulation, DOACs have facilitated the uptake of anticoagulation. The DOACs are approved for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism, and their indications are expanding to include the prevention of atherothrombosis. DOACs have now replaced vitamin K antagonists (VKAs) for most indications, but not all. DOACs are inferior to VKAs for patients with mechanical heart valves, left ventricular assist device, rheumatic atrial fibrillation, and those with antiphospholipid syndrome, and their safety and efficacy are uncertain in some populations (e.g. advanced renal and liver disease). Impediments to use include concerns for bleeding and cost. The newly developed FXIa and FXIIa inhibitors have the potential to be safer than current anticoagulants, but phase 3 trials are needed to confirm their clinical efficacy and safety.

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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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