Peacock William Frank, Levy Phillip D, Gonzalez Michael G, Than Martin
Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas.
Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University, Detroit, Michigan.
J Emerg Med. 2016 Feb;50(2):246-57. doi: 10.1016/j.jemermed.2015.02.052. Epub 2015 Nov 21.
Emergency physicians make treatment decisions in patients who present to the emergency department (ED) with acute venous thromboembolism (VTE). They also encounter patients on target-specific oral anticoagulants (TSOACs) who require urgent intervention. New approvals and increasing prescriptions for TSOACs (e.g., apixaban, dabigatran, edoxaban, and rivaroxaban) for the management of several thromboembolic disorders warrant an evaluation of the impact of these agents in the ED setting.
This review discusses the use of TSOACs in the ED for the treatment of acute VTE, and highlights strategies for the management of patients on TSOACs who present to the ED with other complications, such as bleeding complications or requiring emergency surgery.
Apixaban, dabigatran, edoxaban, and rivaroxaban have been approved for the treatment of acute VTE. We discuss the impact of this on ED management of TSOAC-naïve patients and highlight results with TSOACs in high-risk subgroups including the elderly and those with prior VTE or active cancer. This review also discusses management strategies for patients on TSOACs. For emergency physicians, strategies for the management of bleeding, approaches to patient care when emergency surgery is needed, laboratory assays for measuring plasma concentrations of TSOACs, and drug-drug interactions are of special importance.
Familiarity with TSOACs will better position emergency physicians to provide state-of-the art care to their patients with VTE and help them manage potentially complicated circumstances related to the chronic use of these drugs.
急诊医生需要对因急性静脉血栓栓塞症（VTE）前来急诊科（ED）就诊的患者做出治疗决策。他们还会遇到正在服用特定靶点口服抗凝剂（TSOACs）且需要紧急干预的患者。TSOACs（如阿哌沙班、达比加群、依度沙班和利伐沙班）在几种血栓栓塞性疾病管理方面的新批准及处方量增加，使得有必要评估这些药物在急诊科环境中的影响。
本综述讨论TSOACs在急诊科用于治疗急性VTE的情况，并强调对因其他并发症（如出血并发症或需要急诊手术）前来急诊科就诊的服用TSOACs患者的管理策略。
阿哌沙班、达比加群、依度沙班和利伐沙班已被批准用于治疗急性VTE。我们讨论这对未使用过TSOACs患者的急诊科管理的影响，并强调TSOACs在包括老年人以及既往有VTE或患有活动性癌症的高危亚组中的应用结果。本综述还讨论了服用TSOACs患者的管理策略。对于急诊医生来说，出血管理策略、需要急诊手术时的患者护理方法、测量TSOACs血浆浓度的实验室检测以及药物相互作用尤为重要。
熟悉TSOACs将使急诊医生能够更好地为VTE患者提供最先进的护理，并帮助他们处理与这些药物长期使用相关的潜在复杂情况。
