达比加群、利伐沙班和阿哌沙班所致出血的实用处理方法。

Practical management of bleeding due to the anticoagulants dabigatran, rivaroxaban, and apixaban.

机构信息

Department of Internal Medicine, Fairview Hospital, Cleveland, OH 44111, USA.

出版信息

Cleve Clin J Med. 2013 Jul;80(7):443-51. doi: 10.3949/ccjm.80a.13025.

DOI:10.3949/ccjm.80a.13025

Abstract

The new oral anticoagulants dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) have predictable pharmacokinetic and pharmacodynamic profiles and are alternatives to warfarin. However, many physicians are wary of these drugs, since there is limited evidence on how to manage bleeding in patients taking them, and since no specific antidote is known to reverse their anticoagulant effect. Management requires careful adherence to first principles of bleeding care. Unapproved and untested reversal strategies may be required in patients with life-threatening bleeding.

摘要

新型口服抗凝剂达比加群酯（普伐沙班）、利伐沙班（拜瑞妥）和阿哌沙班（艾乐妥）具有可预测的药代动力学和药效学特征，可作为华法林的替代药物。然而，许多医生对这些药物持谨慎态度，因为关于如何管理服用这些药物的患者的出血问题，证据有限，而且目前还不知道特定的解毒剂来逆转它们的抗凝作用。管理需要仔细遵守出血护理的基本原则。对于有生命危险出血的患者，可能需要使用未经批准和未经测试的逆转策略。