University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
J Thromb Haemost. 2013 Feb;11(2):245-52. doi: 10.1111/jth.12096.
In contrast to vitamin K antagonists, which reduce the functional levels of several coagulation factors, the new oral anticoagulants specifically target either thrombin or factor Xa. These new agents have such predictable pharmacokinetics and pharmacodynamics that routine coagulation monitoring is unnecessary. However, there are still some situations in which measurement of anticoagulant effect may be required. The coagulation assays that are used to monitor heparin derivatives or vitamin K antagonists may not always accurately reflect the anticoagulant activity of the new oral anticoagulants, and specialized assays may be needed. In this article, we: (i) identify situations in which assessment of anticoagulant effect may aid treatment decisions; (ii) describe the effects of the new oral anticoagulants on the various coagulation tests; (iii) review the specialized coagulation assays that have been developed to measure the anticoagulant effects of the new oral anticoagulants; and (iv) provide a clinical perspective on the role of coagulation testing in the clinical management of patients treated with the new oral anticoagulants.
与维生素 K 拮抗剂不同，后者可降低几种凝血因子的功能水平，新型口服抗凝剂专门针对凝血酶或因子 Xa。这些新药物具有如此可预测的药代动力学和药效学，以至于常规凝血监测是不必要的。然而，仍然存在一些需要测量抗凝效果的情况。用于监测肝素衍生物或维生素 K 拮抗剂的凝血检测方法并不总是能准确反映新型口服抗凝剂的抗凝活性，可能需要特殊的检测方法。在本文中，我们：(i)确定评估抗凝效果可能有助于治疗决策的情况；(ii)描述新型口服抗凝剂对各种凝血试验的影响；(iii)综述已开发用于测量新型口服抗凝剂抗凝效果的特殊凝血检测方法；以及 (iv)提供关于凝血检测在接受新型口服抗凝剂治疗的患者的临床管理中的作用的临床观点。
