Ciurus Tomasz, Sobczak Sebastian, Cichocka-Radwan Anna, Lelonek Malgorzata
Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland.
Kardiochir Torakochirurgia Pol. 2015 Jun;12(2):111-8. doi: 10.5114/kitp.2015.52851. Epub 2015 Jun 30.
Oral direct inhibitors of thrombin and activated factor Xa are approved as new anticoagulant drugs. In contrast to vitamin K antagonists (VKA) and heparins, the new agents have single targets in the coagulation cascade and more predictable pharmacokinetics, but they lack validated and available antidotes. Unlike VKA, they do not require routine monitoring of coagulation. However, the measurement of their pharmacologic effects might be of value in selected patients. They interfere with the routine coagulation tests, which should be interpreted with caution. Specific tests exist and can be used in case of emergencies. Adequate supportive care and temporary removal of all antithrombotic agents constitute the basis for management of serious bleeding complications. The administration of coagulation factors, such as fresh frozen plasma, prothrombin complex concentrates or recombinant activated FVII, can benefit in life-threatening bleeding or emergency surgery. Specific antidotes for non-vitamin K oral anticoagulants are in clinical development. This review aims at answering in a brief and simplified manner some clinical questions.
凝血酶和活化因子Xa的口服直接抑制剂已被批准作为新型抗凝药物。与维生素K拮抗剂（VKA）和肝素不同，这些新型药物在凝血级联反应中有单一靶点，药代动力学更具可预测性，但它们缺乏经过验证且可用的解毒剂。与VKA不同，它们不需要常规监测凝血功能。然而，对其药理作用进行测量可能对特定患者有价值。它们会干扰常规凝血试验，对此应谨慎解读。有特定的检测方法，可在紧急情况下使用。充分的支持性护理和暂时停用所有抗血栓药物是严重出血并发症管理的基础。输注凝血因子，如新鲜冰冻血浆、凝血酶原复合物浓缩剂或重组活化FVII，可用于治疗危及生命的出血或急诊手术。非维生素K口服抗凝剂的特异性解毒剂正在临床研发中。本综述旨在以简要和简化的方式回答一些临床问题。
