Dahl Ola E
Department of Orthopaedics, Innlandet Hospital Trust, Elverum Central Hospital, Elverum, Norway.
Vasc Health Risk Manag. 2012;8:45-57. doi: 10.2147/VHRM.S26482. Epub 2012 Jan 25.
Venous thromboembolism, presenting as deep vein thrombosis or pulmonary embolism, is a major challenge for health care systems. It is the third most common vascular disease after coronary heart disease and stroke, and many hospitalized patients have at least one risk factor. In particular, patients undergoing hip or knee replacement are at risk, with an incidence of asymptomatic deep vein thrombosis of 40%-60% without thromboprophylaxis. Venous thromboembolism is associated with significant mortality and morbidity, with patients being at risk of recurrence, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Arterial thromboembolism is even more frequent, and atrial fibrillation, the most common embolic source (cardiac arrhythmia), is associated with a five-fold increase in the risk of stroke. Strokes due to atrial fibrillation tend to be more severe and disabling and are more often fatal than strokes due to other causes. Currently, recommended management of both venous and arterial thromboembolism involves the use of anticoagulants such as coumarin and heparin derivatives. These agents are effective, although have characteristics that prevent them from providing optimal anticoagulation and convenience. Hence, new improved oral anticoagulants are being investigated. Dabigatran is a reversible, direct thrombin inhibitor, which is administered as dabigatran etexilate, the oral prodrug. Because it is the first new oral anticoagulant that has been licensed in many countries worldwide for thromboprophylaxis following orthopedic surgery and for stroke prevention in patients with atrial fibrillation, this compound will be the main focus of this review. Dabigatran has been investigated for the treatment of established venous thromboembolism and prevention of recurrence in patients undergoing hip or knee replacement, as well as for stroke prevention in atrial fibrillation patients with a moderate and high risk of stroke.
静脉血栓栓塞表现为深静脉血栓形成或肺栓塞，是医疗保健系统面临的一项重大挑战。它是仅次于冠心病和中风的第三大常见血管疾病，许多住院患者至少有一个风险因素。特别是接受髋关节或膝关节置换手术的患者处于风险之中，在没有进行血栓预防的情况下，无症状深静脉血栓形成的发生率为40%-60%。静脉血栓栓塞与显著的死亡率和发病率相关，患者有复发、血栓后综合征和慢性血栓栓塞性肺动脉高压的风险。动脉血栓栓塞更为常见，而房颤是最常见的栓子来源（心律失常），与中风风险增加五倍相关。房颤导致的中风往往比其他原因导致的中风更严重、更致残，且更常致命。目前，推荐的静脉和动脉血栓栓塞的治疗方法包括使用香豆素和肝素衍生物等抗凝剂。这些药物是有效的，尽管其特性使其无法提供最佳的抗凝效果和便利性。因此，正在研究新型改良口服抗凝剂。达比加群是一种可逆的直接凝血酶抑制剂，以达比加群酯（口服前体药物）的形式给药。由于它是全球许多国家首个获批用于骨科手术后血栓预防以及房颤患者中风预防的新型口服抗凝剂，该化合物将成为本综述的主要焦点。达比加群已被研究用于治疗已确诊的静脉血栓栓塞以及预防髋关节或膝关节置换患者的复发，还用于中风中度和高度风险的房颤患者的中风预防。
