Beyer-Westendorf Jan, Ageno Walter
Jan Beyer-Westendorf, Center for Vascular Diseases and Medical Clinic III, Dresden University Hospital "Carl Gustav Carus", Fetscherstraße 74, 01307 Dresden, Germany, Tel.: +49 351 4582236, Fax: +49 351 4585809, E-mail:
Thromb Haemost. 2015 Feb;113(2):231-46. doi: 10.1160/TH14-06-0484. Epub 2014 Oct 16.
The prevention and treatment of venous thromboembolism (VTE) remains a clinical challenge, primarily owing to drawbacks associated with the use of heparins and vitamin K antagonists (VKAs). These and other factors, including a growing elderly population, mean that VTE presents a continuing burden to patients and physicians. Anticoagulant therapy is a fundamental approach for VTE management. Non-VKA oral anticoagulants, including the factor Xa inhibitors apixaban, edoxaban and rivaroxaban, and the thrombin inhibitor dabigatran, have been studied in phase III trials across a spectrum of thromboembolic disorders. These agents offer simplified care, with similar or improved efficacy and safety outcomes compared with heparins and vitamin K antagonists. There are several factors a physician must consider when prescribing an anticoagulant. An important consideration with all anticoagulant use is bleeding risk, especially in high-risk groups such as the elderly or those with renal impairment or cancer. In orthopaedic patients, other risks include a need for surgical revision or blood transfusion, or wound complications. Therefore, the clinical benefits of an anticoagulant should ideally be balanced with any risks associated with the therapy. Quantitative benefit-risk assessments are lacking, and owing to differences in trial design the non-VKA oral anticoagulants cannot be compared directly. Based on trial and "real-life" data, this review will summarise the clinical data for the non-VKA oral anticoagulants in the prevention and treatment of VTE, focusing on the balance between the benefits and risks of anticoagulation with these drugs, and their potential impact on VTE management.
静脉血栓栓塞症（VTE）的预防和治疗仍然是一项临床挑战，主要是由于使用肝素和维生素K拮抗剂（VKA）存在弊端。这些因素以及其他因素，包括老年人口的不断增加，意味着VTE给患者和医生带来持续的负担。抗凝治疗是VTE管理的基本方法。非VKA口服抗凝剂，包括Xa因子抑制剂阿哌沙班、依度沙班和利伐沙班，以及凝血酶抑制剂达比加群，已在一系列血栓栓塞性疾病的III期试验中进行了研究。与肝素和维生素K拮抗剂相比，这些药物提供了简化的治疗，疗效和安全性结果相似或有所改善。医生在开抗凝剂处方时必须考虑几个因素。所有抗凝剂使用中的一个重要考虑因素是出血风险，特别是在老年或有肾功能损害或癌症等高危人群中。在骨科患者中，其他风险包括需要进行手术翻修或输血，或伤口并发症。因此，抗凝剂的临床益处理想情况下应与该治疗相关的任何风险相平衡。目前缺乏定量的效益-风险评估，并且由于试验设计的差异，无法直接比较非VKA口服抗凝剂。基于试验和“现实生活”数据，本综述将总结非VKA口服抗凝剂在预防和治疗VTE方面的临床数据，重点关注这些药物抗凝的益处和风险之间的平衡，以及它们对VTE管理的潜在影响。
