Geldhof Vincent, Vandenbriele Christophe, Verhamme Peter, Vanassche Thomas
Division of Internal Medicine, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium.
Vascular Medicine and Haemostasis, Division of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium.
Thromb J. 2014 Oct 13;12:21. doi: 10.1186/1477-9560-12-21. eCollection 2014.
Increasing age and renal impairment are risk factors for venous thrombosis but also for anticoagulant-induced bleeding. In large-scale phase III trials, non-VKA oral anticoagulants (NOACs) were at least as effective and safe for the treatment of acute venous thromboembolism as warfarin. Here, we review the efficacy and safety of dabigatran, rivaroxaban, apixaban and edoxaban in the subgroups of elderly patients (≥75 years) and patients with impaired renal function (creatinine clearance ≤50 ml/min). In all phase III trials, the efficacy of NOACs in the prevention of recurrent VTE was conserved both in the elderly subgroup and in the subgroup with impaired renal function. In a meta-analysis of the pooled results, NOACs reduced VTE recurrence compared with warfarin in elderly patients. In elderly patients and patients with impaired renal function, the safety of NOACs was in line with the results of the overall study. NOACs may offer an effective, safer and more convenient alternative for VKAs also in the elderly. However, the efficacy/safety profile of NOACs in the aged population needs to be confirmed in real-life.
年龄增长和肾功能损害是静脉血栓形成的危险因素，同时也是抗凝药物所致出血的危险因素。在大规模III期试验中，非维生素K拮抗剂口服抗凝药（NOACs）在治疗急性静脉血栓栓塞方面至少与华法林一样有效且安全。在此，我们综述达比加群、利伐沙班、阿哌沙班和依度沙班在老年患者（≥75岁）和肾功能受损患者（肌酐清除率≤50 ml/min）亚组中的疗效和安全性。在所有III期试验中，NOACs在预防复发性静脉血栓栓塞方面的疗效在老年亚组和肾功能受损亚组中均得以保持。在对汇总结果的荟萃分析中，与华法林相比，NOACs在老年患者中降低了静脉血栓栓塞的复发率。在老年患者和肾功能受损患者中，NOACs的安全性与总体研究结果一致。NOACs在老年人中可能也为维生素K拮抗剂提供了一种有效、更安全且更方便的替代药物。然而，NOACs在老年人群中的疗效/安全性概况需要在现实生活中得到证实。
