新型口服抗凝剂:对患者评估、治疗开始、随访和围手术期管理的建议。

S. Baumann, A. Huseynov, I. El-Battrawy, M. Renker, I. Akin
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引用次数: 1

摘要

新的口服抗凝剂(NOACs)正在成为维生素K拮抗剂(vka)的替代品,用于预防非瓣膜性心房颤动患者的全身栓塞,预防和治疗静脉血栓栓塞和肺栓塞。全面了解止血学的基本概念、潜在药理学、药物相互作用和潜在并发症的管理,对于选择合适的患者接受NOACs、正确的处方和最佳的患者治疗至关重要。此外,在围手术期使用noac是至关重要的,因为它需要了解最后一次服药的时间和剂量、当前肾功能和计划的手术,以评估出血的总体风险。虽然没有解毒剂可以逆转这些新药的作用,但选择性替代凝血因子和透析可能是必要的。因此,在个体基础上选择最有益的vka替代方案对医生来说是具有挑战性的。总之,最近引进的noac为抗凝治疗方案提供了机会,但应仔细考虑其益处、风险和局限性。本系统综述的目的是突出noac与vka的特点,并提供在多方面决策过程中应考虑的实用指导,以提高疗效和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel Oral Anticoagulants: Recommendations for Patient Evaluation, Treatment Initiation, Follow-up and Perioperative Management.
New oral anticoagulants (NOACs) are becoming available as alternatives to vitamin K antagonists (VKAs) to prevent systemic embolism in patients with non-valvular atrial fibrillation for the prevention and treatment of venous thromboembolism and pulmonary embolism. A comprehensive understanding of the basic concepts of hemostaseology, the underlying pharmacology, drug interactions and management of potential complications is essential for the selection of suitable patients to receive NOACs, for correct prescription and for optimal patient treatment. Furthermore, the use of NOACs in a perioperative setting is crucial, as it requires knowledge of time and dose of last intake of drug, current renal function and the planned procedure in order to assess the overall risk of bleeding. Although no antidote exists to reverse the effects of these novel drugs, selective substitution of coagulation factors and dialysis may be necessary. Therefore, choosing the most beneficial alternative to VKAs on an individual basis can be challenging for physicians. In conclusion, the recent introduction of NOACs represents an opportunity for anticoagulative treatment regimes, while the benefits, risks and limitations should be reflected carefully. The purpose of this systematic review is to highlight features and to provide practical guidance of NOACs in comparison with VKAs that should be considered in a multifaceted decision making process to improve efficacy and safety.
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