Yang Eugene
Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA.
Vasc Health Risk Manag. 2014 Aug 21;10:507-22. doi: 10.2147/VHRM.S68117. eCollection 2014.
Over the past few years, three novel oral anticoagulants, dabigatran, rivaroxaban, and apixaban, have been approved in the USA and Europe to reduce the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation, and the results of a Phase III trial for a fourth novel oral anticoagulant, edoxaban, have recently been published. The aim of this review is to examine this indication from a clinician's perspective, highlighting efficacy and safety results from the major trials with these novel oral agents. Clinical issues regarding bleeding, monitoring, and reversal are discussed, along with requirements to consider when interrupting treatment with a novel oral anticoagulant for the purpose of transitioning to another anticoagulant and prior to cardioversion, ablation, percutaneous coronary intervention, or emergency surgery. The cost-effectiveness of each of the approved novel oral anticoagulants is reviewed, and the author provides recommendations for selecting appropriate patients for these agents.
在过去几年中，三种新型口服抗凝剂——达比加群、利伐沙班和阿哌沙班，已在美国和欧洲获批，用于降低非瓣膜性心房颤动患者中风或全身性栓塞的风险，并且第四种新型口服抗凝剂依度沙班的III期试验结果最近已发表。本综述的目的是从临床医生的角度审视这一适应症，突出这些新型口服药物主要试验的疗效和安全性结果。讨论了有关出血、监测和逆转的临床问题，以及在为过渡到另一种抗凝剂而中断新型口服抗凝剂治疗时，以及在心脏复律、消融、经皮冠状动脉介入治疗或急诊手术之前需要考虑的要求。对每种已获批的新型口服抗凝剂的成本效益进行了综述，作者还为选择适合使用这些药物的患者提供了建议。
