Fenger-Eriksen C, Münster A-M, Grove E L
Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark.
Acta Anaesthesiol Scand. 2014 Jul;58(6):651-9. doi: 10.1111/aas.12319. Epub 2014 Apr 9.
New oral anticoagulants like the direct thrombin inhibitor, dabigatran (Pradaxa®), and factor Xa-inhibitors, rivaroxaban (Xarelto®) and apixaban (Eliquis®) are available for prophylaxis and treatment of thromboembolic disease. They are emerging alternatives to warfarin and provide equal or better clinical outcome together with reduced need for routine monitoring. Methods for measuring drug concentrations are available, although a correlation between plasma drug concentrations and the risk of bleeding has not been firmly established. Standard laboratory measures like prothrombin time and activated partial thromboplastin time are not sensitive enough to detect thrombin or factor Xa inhibition provided by new oral anticoagulants. Thus, these standard tests may only be used as a crude estimation of the actual anticoagulation status. Further challenges regarding patients receiving new oral anticoagulants who presents with major bleeding or need for emergency surgery pose a unique problem. No established agents are clinically available to reverse the anticoagulant effect, although preclinical data report prothrombin complex concentrate as more efficient than fresh frozen plasma or other prohaemostatic agents. This review summaries current knowledge on approved new oral anticoagulants and discusses clinical aspects of monitoring, with particular focus on the management of the bleeding patient.
新型口服抗凝药，如直接凝血酶抑制剂达比加群（Pradaxa®）以及Xa因子抑制剂利伐沙班（Xarelto®）和阿哌沙班（Eliquis®），可用于预防和治疗血栓栓塞性疾病。它们是华法林的新兴替代药物，能提供同等或更好的临床疗效，同时减少了常规监测的需求。虽然有测量药物浓度的方法，但血浆药物浓度与出血风险之间的相关性尚未完全确立。像凝血酶原时间和活化部分凝血活酶时间这样的标准实验室检测，对于检测新型口服抗凝药所产生的凝血酶或Xa因子抑制作用不够敏感。因此，这些标准检测仅可作为实际抗凝状态的粗略估计。对于接受新型口服抗凝药治疗且出现大出血或需要紧急手术的患者，还存在其他挑战，这构成了一个独特的问题。目前临床上尚无已确立的药物可逆转抗凝作用，尽管临床前数据表明凝血酶原复合物浓缩剂比新鲜冰冻血浆或其他止血药物更有效。本综述总结了关于已获批新型口服抗凝药的现有知识，并讨论了监测的临床方面，特别关注出血患者的管理。
