Harter Katherine, Levine Michael, Henderson Sean O
University of Southern California, LA+USC Medical Center, Department of Emergency Medicine, Los Angeles, California.
West J Emerg Med. 2015 Jan;16(1):11-7. doi: 10.5811/westjem.2014.12.22933. Epub 2015 Jan 12.
Historically, most patients who required parenteral anticoagulation received heparin, whereas those patients requiring oral anticoagulation received warfarin. Due to the narrow therapeutic index and need for frequent laboratory monitoring associated with warfarin, there has been a desire to develop newer, more effective anticoagulants. Consequently, in recent years many novel anticoagulants have been developed. The emergency physician may institute anticoagulation therapy in the short term (e.g. heparin) for a patient being admitted, or may start a novel anticoagulation for a patient being discharged. Similarly, a patient on a novel anticoagulant may present to the emergency department due to a hemorrhagic complication. Consequently, the emergency physician should be familiar with the newer and older anticoagulants. This review emphasizes the indication, mechanism of action, adverse effects, and potential reversal strategies for various anticoagulants that the emergency physician will likely encounter.
从历史上看，大多数需要胃肠外抗凝治疗的患者接受肝素治疗，而那些需要口服抗凝治疗的患者则接受华法林治疗。由于华法林的治疗指数较窄且需要频繁进行实验室监测，因此人们一直希望开发更新、更有效的抗凝剂。因此，近年来已经开发出许多新型抗凝剂。急诊医生可能会在短期内为入院患者进行抗凝治疗（例如肝素），或者为出院患者启动新型抗凝治疗。同样，正在使用新型抗凝剂的患者可能因出血并发症而就诊于急诊科。因此，急诊医生应该熟悉新旧抗凝剂。本综述重点介绍了急诊医生可能会遇到的各种抗凝剂的适应证、作用机制、不良反应和潜在的逆转策略。
