University Hospital S. Orsola-Malpighi of Bologna, Bologna, Italy.
Hamostaseologie. 2011 Nov;31(4):237-42. doi: 10.5482/ha-1151. Epub 2011 Jun 28.
Anticoagulation with vitamin K antagonists (VKAs) is effective in the prevention and treatment of thrombotic complications in many clinical conditions, including atrial fibrillation (that represents today the most frequent indication for anticoagulant treatment), venous thromboembolism, acute coronary syndromes and after invasive cardiac procedures. Bleeding is the most important complication of VKAs and a major concern for both physicians and patients, limiting a more widespread prescription of the treatment. As a result, a non negligible proportion of all the subjects who would have a clear clinical indication for anticoagulation do not receive an effective treatment. This review analyses the treatment- and person-associated risk factors for bleeding during VKAs. New oral anticoagulant drugs seems to overcome at least some of the limitations of VKAs. Potentially, they can allow a less demanding and more stable anticoagulant treatment, with less side-effects allowing that more patients can receive an appropriate anticoagulant treatment. Based on the so far available phase III clinical studies, it is possible to assume that these new drugs are associated with a risk of bleeding, that is probably related to the intensity of treatment.
维生素 K 拮抗剂（VKAs）抗凝治疗在许多临床情况下，包括心房颤动（目前抗凝治疗最常见的适应证）、静脉血栓栓塞、急性冠状动脉综合征和心脏介入治疗后，预防和治疗血栓并发症是有效的。出血是 VKAs 最主要的并发症，也是医生和患者最关心的问题，这限制了更广泛的治疗处方。因此，相当一部分有明确抗凝临床适应证的患者未接受有效的治疗。本文分析了 VKAs 治疗期间出血的治疗相关和个体相关危险因素。新型口服抗凝药物似乎至少克服了 VKAs 的一些局限性。它们可能会允许一种要求不那么高、更稳定的抗凝治疗，副作用更少，使更多的患者能够接受适当的抗凝治疗。基于迄今为止的 III 期临床研究，可以假设这些新药与出血风险相关，这可能与治疗强度有关。
