Department of Medicine and Hematology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA.
Oncologist. 2014 Jan;19(1):82-93. doi: 10.1634/theoncologist.2013-0239. Epub 2013 Dec 6.
Indications for anticoagulation are common in patients with malignancy. Cancer patients have an increased risk of developing venous thromboembolic events or may have other indications for anticoagulation, such as atrial fibrillation. New oral anticoagulants (NOACs) are now available that offer increased options for anticoagulation beyond the traditional vitamin K antagonists and low molecular weight heparins that have long been the cornerstone of treatment. This review will focus on the three NOACs that are currently approved for use in the U.S.: the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors, apixaban and rivaroxaban. Oncologists are likely to encounter an increasing number of patients taking these agents at the time of their cancer diagnosis or to have patients who develop indications for anticoagulation during the course of their disease. The basic pharmacology, current clinical indications, and approach to the use of NOACs in the cancer patient will be reviewed.
抗凝的适应证在恶性肿瘤患者中很常见。癌症患者发生静脉血栓栓塞事件的风险增加，或者可能有其他抗凝适应证，如心房颤动。现在有新的口服抗凝剂 (NOACs) 可供使用，除了传统的维生素 K 拮抗剂和长期以来一直是治疗基石的低分子量肝素之外，为抗凝提供了更多选择。这篇综述将重点介绍目前在美国获准使用的三种 NOAC：直接凝血酶抑制剂达比加群，以及因子 Xa 抑制剂阿哌沙班和利伐沙班。肿瘤学家可能会在癌症诊断时遇到越来越多服用这些药物的患者，或者在疾病过程中患者出现抗凝适应证。本文将回顾 NOAC 在癌症患者中的基本药理学、当前临床适应证以及使用方法。
