Department of Medicine, Vascular Medicine Unit, University of Padua, Padua, Italy.
Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
Semin Hematol. 2014 Apr;51(2):121-30. doi: 10.1053/j.seminhematol.2014.03.006. Epub 2014 Mar 29.
Hospitalized medical and surgical patients encompass a group of patients in whom venous thromboembolism (VTE) poses a major concern on morbidity and mortality. Recently, direct oral anticoagulants for the prevention of VTE have been developed to overcome the drawbacks of the food/drug interactions and the need for frequent laboratory monitoring and dose adjustments associated with the use of vitamin K antagonists and the inconvenience of the subcutaneous administration of low-molecular-weight heparins and fondaparinux. The novel oral anticoagulants that have been tested in major clinical trials for VTE prevention in medical and surgical patients are the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, rivaroxaban, and edoxaban, which will be the focus of this review. While the new drugs proved to be highly effective and safe in the prevention of VTE following major orthopedic surgery, they failed to show a favorable benefit-to-risk profile in hospitalized medical patients receiving extended anticoagulation beyond the hospital stay.
住院的内科和外科患者构成了一组主要存在静脉血栓栓塞(VTE)风险的患者群体,其发病率和死亡率都很高。最近,为了克服维生素 K 拮抗剂相关的药物食物相互作用、频繁实验室监测和剂量调整的缺点,以及皮下给予低分子肝素和磺达肝癸钠不方便的问题,已经开发出用于预防 VTE 的直接口服抗凝剂。在预防内科和外科患者 VTE 的主要临床试验中已经测试了新型口服抗凝剂,即凝血酶抑制剂达比加群和因子 Xa 抑制剂阿哌沙班、利伐沙班和依度沙班,这将是本次综述的重点。虽然这些新药在预防骨科大手术后 VTE 方面被证明非常有效且安全,但在接受超过住院时间的延长抗凝治疗的住院内科患者中,它们未能显示出有利的获益-风险特征。