Department of Anesthesiology, Emory University School of Medicine and Emory Healthcare, Atlanta, Georgia 30322, USA.
Anesthesiology. 2010 Sep;113(3):726-45. doi: 10.1097/ALN.0b013e3181ebdb15.
Patients undergoing surgery receive anticoagulation for perioperative thromboprophylaxis or ischemic cardiovascular disease. Because anticoagulants may also potentiate bleeding, clinicians need to understand the implications of anticoagulation in perioperative and postoperative patient management. Many newer anticoagulants that are now available or are in clinical development do not require routine coagulation monitoring, have more predictable dose responses, and have fewer interactions with other drugs and food. The most advanced oral anticoagulants in clinical development are the direct factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran etexilate. These agents have been evaluated in the postoperative setting in patients undergoing total hip- or knee-replacement surgery with promising results, and it remains to be seen whether these results will translate into other surgical settings. The impact of the new agents will be influenced by the balance between efficacy and safety, improved convenience, and potential cost-effectiveness benefits.
接受手术的患者会接受抗凝治疗以预防围手术期血栓形成或缺血性心血管疾病。由于抗凝剂也可能会增强出血风险，临床医生需要了解抗凝治疗对围手术期和术后患者管理的影响。现在有许多新型抗凝药物可供使用或正在临床开发中，它们不需要常规凝血监测，具有更可预测的剂量反应，并且与其他药物和食物的相互作用更少。在临床开发中最先进的口服抗凝剂是直接因子 Xa 抑制剂利伐沙班和阿哌沙班，以及直接凝血酶抑制剂达比加群酯。这些药物已在接受全髋关节或膝关节置换术的患者的术后环境中进行了评估，结果令人鼓舞，而这些结果是否会转化为其他手术环境仍有待观察。新型药物的影响将受到疗效和安全性之间的平衡、便利性的提高以及潜在的成本效益优势的影响。
