Bura-Rivière Alessandra
Service de médecine vasculaire, centre hospitalo-universitaire de Toulouse, faculté de médecine, université Paul-Sabatier, 31 059 Toulouse Cedex 9, France.
Rev Prat. 2013 Sep;63(7):980-4.
Anticoagulant therapy is the cornerstone of treatment of venous thromboembolism (VTE). The treatment needs rapid initial anticoagulaton to minimize the risk of thrombus extension and fata pulmonary embolism, followed by an extended anticoagulation, aimed at preventing recurrent VTE. Till very recently, immediate anticoagulation can only be achieved with parenteral agents, such as heparin, low-molecular-weight heparin, or fondaparinux. Extended treatment usually involves the administration of vitamin K antagonists, such as warfarin. Emerging direct oral anticoagulants have the potential to streamline VTE treatment. These agents include oral anticoagulants that target thrombin or factor Xa. This article reviews the characteristics of these agents, describes the results of clinical trials in venous thromboembolic disease and outlines their strengths and weakness.
抗凝治疗是静脉血栓栓塞症(VTE)治疗的基石。该治疗需要迅速进行初始抗凝,以将血栓扩展和致命性肺栓塞的风险降至最低,随后进行长期抗凝,旨在预防VTE复发。直到最近,立即抗凝只能通过肠外药物来实现,如肝素、低分子肝素或磺达肝癸钠。长期治疗通常涉及给予维生素K拮抗剂,如华法林。新型直接口服抗凝剂有可能简化VTE治疗。这些药物包括靶向凝血酶或Xa因子的口服抗凝剂。本文回顾了这些药物的特点,描述了静脉血栓栓塞性疾病的临床试验结果,并概述了它们的优缺点。