Toth Peter P
CGH Medical Center, Sterling, IL, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; University of Illinois School of Medicine, Peoria, IL, USA.
Vasc Health Risk Manag. 2016 Feb 10;12:23-34. doi: 10.2147/VHRM.S88088. eCollection 2016.
Patients who have had a venous thromboembolic event are generally advised to receive anticoagulant treatment for 3 months or longer to prevent a recurrent episode. Current guidelines recommend initial heparin and an oral vitamin K antagonist (VKA) for long-term anticoagulation. However, because of the well-described disadvantages of VKAs, including extensive food and drug interactions and the need for regular anticoagulation monitoring, novel oral anticoagulants (NOACs) have become an attractive option in recent years. These agents are given at fixed doses and do not require routine coagulation-time monitoring. The NOACs are discussed in this review with regard to the needs of patients on long-term anticoagulation.
Current guidelines from Europe and North America that refer to the treatment of deep vein thrombosis and/or pulmonary embolism are included, as well as published randomized Phase III clinical trials of NOACs. PubMed searches were used for sourcing case studies of long-term anticoagulant treatment, and results were filtered for human application and screened for relevance.
NOAC-based therapy showed a similar efficacy and safety profile to heparins/VKAs but without the need for regular anticoagulation monitoring or dietary adjustments, and can be taken as a fixed-dose regimen once or twice daily. This represents a significant step forward in facilitating the management of long-term anticoagulation therapy. Furthermore, in the EINSTEIN studies, improved patient satisfaction was documented with the NOAC rivaroxaban, which may result in better adherence to therapy and an overall reduction in the incidence of recurrent venous thromboembolism.
发生静脉血栓栓塞事件的患者通常建议接受3个月或更长时间的抗凝治疗，以预防复发。当前指南推荐初始使用肝素和口服维生素K拮抗剂（VKA）进行长期抗凝。然而，由于VKA存在诸多已明确的缺点，包括广泛的食物和药物相互作用以及需要定期进行抗凝监测，近年来新型口服抗凝药（NOAC）已成为一个有吸引力的选择。这些药物以固定剂量给药，无需常规凝血时间监测。本综述将根据长期抗凝患者的需求对NOAC进行讨论。
纳入欧洲和北美的当前指南，这些指南涉及深静脉血栓形成和/或肺栓塞的治疗，以及已发表的NOAC的随机III期临床试验。使用PubMed搜索来获取长期抗凝治疗的病例研究，并对结果进行筛选，以确定其是否适用于人类并筛选相关性。
基于NOAC的治疗显示出与肝素/VKA相似的疗效和安全性，但无需常规抗凝监测或饮食调整，且可以每日一次或两次的固定剂量方案服用。这代表了在促进长期抗凝治疗管理方面向前迈出的重要一步。此外，在EINSTEIN研究中，记录到使用NOAC利伐沙班可提高患者满意度，这可能导致更好的治疗依从性，并总体降低复发性静脉血栓栓塞的发生率。
