Ola Ali, Awab Elnaeem, Manmeet Kaur, Nitisha Thatikonda, Julia Aigbogun, A. K. M. Muktadir
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引用次数: 0
Abstract
This article aims to discuss the literature on switching to an anticoagulant with a different mechanism of action in case of treatment failure. We present a patient with atrial fibrillation who incurred an embolic stroke despite adequate anticoagulation with apixaban and developed a new symptomatic ischemic stroke during the same admission after switching to rivaroxaban, a factor Xa inhibitor with a similar mechanism of action. He had no new events at 3-months after switching to dabigatran, a direct thrombin inhibitor. We identified no apparent reason for anticoagulation failure in our patient. The literature on switching anticoagulants in case of failure is inconclusive with no strong supportive evidence. More research is needed to define anticoagulation failure and identify cases with factor Xa inhibitor resistance, in which switching to a different mechanism of anticoagulation may be appropriate.
本文旨在讨论在治疗失败的情况下改用作用机制不同的抗凝剂的文献。我们介绍了一名心房颤动患者，尽管他使用阿哌沙班进行了充分的抗凝治疗，但仍发生了栓塞性脑卒中，在改用具有类似作用机制的 Xa 因子抑制剂利伐沙班治疗后，他在入院的同一天又发生了新的症状性缺血性脑卒中。在改用达比加群（一种直接凝血酶抑制剂）3 个月后，他没有发生新的事件。我们没有发现患者抗凝失败的明显原因。关于在抗凝失败的情况下更换抗凝药物的文献尚无定论，也没有有力的支持证据。需要开展更多研究来定义抗凝失败，并确定 Xa 因子抑制剂耐药的病例，在这些病例中，换用不同的抗凝机制可能是合适的。
期刊介绍：
Clinical Case Reports is different from other case report journals. Our aim is to directly improve global health and increase clinical understanding using case reports to convey important best practice information. We welcome case reports from all areas of Medicine, Nursing, Dentistry, and Veterinary Science and may include: -Any clinical case or procedure which illustrates an important best practice teaching message -Any clinical case or procedure which illustrates the appropriate use of an important clinical guideline or systematic review. As well as: -The management of novel or very uncommon diseases -A common disease presenting in an uncommon way -An uncommon disease masquerading as something more common -Cases which expand understanding of disease pathogenesis -Cases where the teaching point is based on an error -Cases which allow us to re-think established medical lore -Unreported adverse effects of interventions (drug, procedural, or other).
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