Pluym Mark, Howell Gregory
Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO.
Hosp Pract (1995). 2014 Aug;42(3):75-83. doi: 10.3810/hp.2014.08.1120.
The target-specific oral anticoagulants have recently been introduced as alternatives to warfarin for both prophylactic and therapeutic indications. Although their efficacy and side-effect profiles have been favorable, there is significant concern about management of hemorrhage with these agents as there is no direct reversal agent available. It is important for clinicians to be aware of these agents and the issues that surround them. Most of the management of hemorrhage is based on expert opinion and case reviews. Given the potentially catastrophic consequences of acute hemorrhage while patients are on anticoagulation, specific treatments are needed. Some methods that have been described include activated charcoal, hemodialysis, prohemostatic agents, and transfusions. Target-specific therapies have been shown to be effective in early studies in animal models; however, the effects in humans are still under investigation. More investigation is needed on the management of bleeding complications from target-specific oral anticoagulants.
近期，针对特定靶点的口服抗凝剂已作为华法林的替代药物，用于预防和治疗相关适应症。尽管它们的疗效和副作用表现良好，但由于没有直接的逆转剂，这些药物的出血管理问题备受关注。临床医生了解这些药物及其相关问题非常重要。大多数出血管理是基于专家意见和病例回顾。鉴于患者在抗凝治疗期间急性出血可能产生灾难性后果，需要特定的治疗方法。已描述的一些方法包括活性炭、血液透析、促凝血剂和输血。在动物模型的早期研究中，针对特定靶点的疗法已显示出有效性；然而，其对人类的影响仍在研究中。对于针对特定靶点的口服抗凝剂引起的出血并发症管理，还需要更多研究。
