Division of Angiology and Hemostaseology, Department of Internal Medicine, University Hospital Frankfurt, Germany. edelgard.lindhoff
Ann Med. 2013 Sep;45(5-6):423-9. doi: 10.3109/07853890.2013.801274. Epub 2013 Jun 7.
A number of target-specific oral anticoagulants (TSOAs) have been developed in recent years, and some have shown considerable promise in large-scale, randomized clinical trials in the prevention and treatment of thromboembolism. Unlike traditional anticoagulants, such as vitamin K antagonists, these TSOAs exhibit predictable pharmacokinetics and pharmacodynamics. Among these agents, rivaroxaban, a direct Factor Xa inhibitor, has been approved for clinical use in many countries for the management of several thromboembolic disorders. As with the other TSOAs, rivaroxaban is given at fixed doses without routine coagulation monitoring. However, in certain patient populations or special clinical circumstances, measurement of drug exposure may be useful, such as in suspected overdose, in patients with a haemorrhagic or thromboembolic event during treatment with an anticoagulant, in those with acute renal failure, or in patients who require urgent surgery. This article summarizes the influence of rivaroxaban on commonly used coagulation assays and provides practical guidance on laboratory testing of rivaroxaban in routine practice. Both quantitative measurement (using the anti-Factor Xa method) and qualitative measurement (using prothrombin time, expressed in seconds) are discussed, together with some practical considerations when performing these tests and interpreting the test results.
近年来，已经开发出了许多针对特定靶点的口服抗凝剂（TSOAs），并且一些在预防和治疗血栓栓塞方面的大规模随机临床试验中表现出了相当大的潜力。与传统抗凝剂（如维生素 K 拮抗剂）不同，这些 TSOAs 表现出可预测的药代动力学和药效学。在这些药物中，直接因子 Xa 抑制剂利伐沙班已在许多国家获得批准，用于治疗多种血栓栓塞性疾病。与其他 TSOAs 一样，利伐沙班以固定剂量给药，无需常规凝血监测。然而，在某些患者群体或特殊临床情况下，测量药物暴露可能是有用的，例如在疑似药物过量时、在抗凝治疗期间发生出血或血栓栓塞事件的患者中、在急性肾衰竭患者中，或在需要紧急手术的患者中。本文总结了利伐沙班对常用凝血检测的影响，并提供了在常规实践中检测利伐沙班的实验室检测的实用指南。讨论了定量测量（使用抗因子 Xa 法）和定性测量（使用秒表示的凝血酶原时间），以及在进行这些检测和解释检测结果时的一些实际考虑因素。
