Fiessinger Jean-Noël
Service de médecine vasculaire et d'hypertension artérielle, Hôpital européen Georges-Pompidou, AP-HP, université Paris-Descartes, 75908 Paris Cedex 15.
Rev Prat. 2010 May 20;60(5):613-6.
Two new oral anticoagulants are licensed in France for prevention for venous thromboembolism in patients undergoing hip or knee arthroplasty. Dabigatran (Pradaxa) inhibits the active site of thrombin. The 220-mg dose is recommended for the majority of patients whereas the 150-mg dose is reserved for patients also taking amiodarone and for those at higher risk for bleeding (patients with moderate renal insufficiency). Rivaroxan (Xarelto) inhibits reversibly the active site of fXa, the 10 mg-dose once daily is recommended started 6 to 12 hours after wound closure. The two drugs are given once daily in fixed doses without coagulation monitoring. However the aim of the new anticoagulants is to replaced VKAs particularly for prevention of stroke in patients with auricular fibrillation and for the treatment of venous thrombo-embolism. Recently published results in these two indications with dabigatran are very promising.
在法国，两种新型口服抗凝剂已获许可，用于预防髋关节或膝关节置换术患者的静脉血栓栓塞。达比加群（Pradaxa）抑制凝血酶的活性位点。大多数患者推荐使用220毫克剂量，而150毫克剂量则留给同时服用胺碘酮的患者以及出血风险较高的患者（中度肾功能不全患者）。利伐沙班（Xarelto）可逆地抑制Xa因子的活性位点，建议在伤口闭合后6至12小时开始，每日一次服用10毫克剂量。这两种药物每日固定剂量服用一次，无需进行凝血监测。然而，新型抗凝剂的目标是取代维生素K拮抗剂，特别是用于预防心房颤动患者的中风以及治疗静脉血栓栓塞。最近发表的关于达比加群在这两个适应症方面的结果非常有前景。
