Brieger David
MBBS MMed (Clin Epi) PhD, FRACP, Professor, Director of Coronary Care and Coronary Interventions, Department of Cardiology, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW.
Aust Fam Physician. 2014 May;43(5):254-9.
The acceptability of warfarin has been limited by mandatory laboratory monitoring. A number of new orally active anticoagulants (NOACs), which can be used as alternatives to warfarin, are now available.
We review the clinical indications and considerations associated with the use of the NOACs.
The NOACs currently approved in Australia are dabigatran, rivaroxaban and apixaban. Indications include thromboprophylaxis in non-valvular atrial fibrillation and following hip and knee replacement surgery. Rivaroxaban is also approved for treatment and secondary prevention of deep venous thrombosis (DVT) and pulmonary embolus (PE). The NOACs differ from warfarin in that they do not require laboratory monitoring. They need to be used cautiously in patients with renal impairment and are contraindicated in patients with renal failure. Bleeding may require blood product replacement aided by haematological advice and specialist investigations. Antidotes to the NOACS are undergoing clinical trials.
华法林的可接受性因需要强制性实验室监测而受到限制。现在有多种新型口服活性抗凝剂（NOACs）可作为华法林的替代品使用。
我们综述与使用NOACs相关的临床适应证及注意事项。
目前在澳大利亚获批的NOACs有达比加群、利伐沙班和阿哌沙班。适应证包括非瓣膜性心房颤动的血栓预防以及髋关节和膝关节置换术后的血栓预防。利伐沙班还获批用于治疗和二级预防深静脉血栓形成（DVT）和肺栓塞（PE）。NOACs与华法林的不同之处在于它们不需要实验室监测。在肾功能损害患者中需谨慎使用，肾衰竭患者禁用。出血可能需要在血液学建议和专科检查的辅助下进行血液制品替代治疗。NOACs的解毒剂正在进行临床试验。
