Dept. of Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
Hamostaseologie. 2011 Nov;31(4):229-35. doi: 10.5482/ha-1153. Epub 2011 Jun 20.
Anticoagulants are effective in the prevention and treatment of a variety of arterial and venous thrombotic disorders but are associated with an increased risk of serious bleeding complications. Based on well documented studies of patients using vitamin K antagonists the incidence of major bleeding is 0.5%/year and the incidence of intracranial bleeding is 0.2%/year, however, in real life practice this incidence may be even higher. Risk factors for bleeding are the intensity of anticoagulation, the management strategy to keep the anticoagulant effect in the desired range, and patient characteristics. Recently, a new generation of anticoagulants have been developed and is currently evaluated in clinical trials. Initial results show a similar or superior efficacy over conventional anticoagulant agents with a good safety profile. In case of serious bleeding complications in a patient who uses vitamin K antagonists, this anticoagulant treatment can be quickly reversed by administration of vitamin K or coagulation factor concentrates. For the newer anticoagulants, quick reversal strategies are more cumbersome, although some interventions, including prothrombin complex concentrates, show promising results in initial experimental studies.
抗凝剂在预防和治疗各种动脉和静脉血栓性疾病方面有效，但与严重出血并发症的风险增加有关。基于对使用维生素 K 拮抗剂的患者的充分研究，大出血的发生率为 0.5%/年，颅内出血的发生率为 0.2%/年，但在实际临床实践中，这一发生率可能更高。出血的危险因素包括抗凝强度、将抗凝效果保持在预期范围内的管理策略以及患者特征。最近，开发了新一代抗凝剂，并正在临床试验中进行评估。初步结果显示，与传统抗凝剂相比，其疗效相似或更优，且安全性良好。如果使用维生素 K 拮抗剂的患者出现严重出血并发症，可通过给予维生素 K 或凝血因子浓缩物快速逆转该抗凝治疗。对于新型抗凝剂，快速逆转策略较为复杂，尽管一些干预措施，包括凝血酶原复合物浓缩物，在初步实验研究中显示出有前景的结果。
