直接口服抗凝剂:超越便利性

Samuel Ji Quan Koh, Jonathan Jiunn Liang Yap
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引用次数: 0

摘要

自 2010 年美国食品药品管理局批准达比加群为第一种非维生素 K 拮抗剂口服抗凝药或直接口服抗凝药(DOACs)以来,该领域取得了长足的发展,不同 DOACs 的供应量不断增加,使用适应症也在不断扩大。在预防非瓣膜性心房颤动(NVAF)血栓栓塞方面,DOACs 已经取代了自 20 世纪 50 年代以来一直作为一线疗法的华法林。在美国心脏协会(AHA)最新发布的 2023 年心房颤动诊断和管理指南中,1A 级建议为无机械心脏瓣膜或中重度风湿性二尖瓣狭窄病史的抗凝患者开具 DOAC,而不是华法林,以降低死亡率、中风、全身性栓塞和颅内出血的风险。欧洲心脏病学会 2020 年指南2 和亚太地区心脏节律学会 2017 年共识3 也对这一立场表示赞同。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Direct oral anticoagulant: Looking beyond convenience
Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it is now more commonly referred to, there has been much development in the field with increasing availability of different DOACs and an expansion in indications of use. In the prevention of thromboembolism in nonvalvular atrial fibrillation (NVAF), DOACs have overtaken warfarin, which has been first-line therapy since the 1950s. In the most recent 2023 guidelines by the American Heart Association (AHA) for the diagnosis and management of atrial fibrillation, there is a Class 1A recommendation for patients who are candidates for anticoagulation without mechanical heart valve or history of moderate-to-severe rheumatic mitral stenosis to be prescribed DOACs over warfarin to reduce the risk of mortality, stroke, systemic embolism and intracranial haemorrhage.1 This stance is also echoed by the European Society of Cardiology guidelines in 2020,2 and—closer to home—in the Asia Pacific Heart Rhythm Society 2017 Consensus.3
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