Unit of Anesthesia and Intensive Care, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy -
Minerva Anestesiol. 2016 Aug;82(8):884-94. Epub 2016 Apr 28.
New oral anticoagulants (NOACs) have been developed in recent years and are increasingly used in clinical practice. Dabigatran is a direct thrombin (factor II) inhibitor while rivaroxaban, apixaban and edoxaban are direct inhibitors of factor Xa. The European Medicines Agency (EMA) currently approves these NOACs for different clinical uses. NOACs do not require routine monitoring of coagulation although an assessment of anticoagulation activity in these patients may be required in different conditions. NOACs show a similar or lower incidence of bleeding compared with conventional therapies in phase III trials. In case of bleeding, non-specific reversal strategies are available while specific reversal agents are the subject of ongoing trials. The role of this review is to summarize the current knowledge on NOCAs focusing on bleeding management in the perioperative period.
近年来开发了新型口服抗凝剂（NOACs），并越来越多地在临床实践中使用。达比加群是一种直接凝血酶（因子 II）抑制剂，而利伐沙班、阿哌沙班和依度沙班则是因子 Xa 的直接抑制剂。欧洲药品管理局（EMA）目前批准这些 NOACs 用于不同的临床用途。NOACs 不需要常规监测凝血，但在不同情况下可能需要评估这些患者的抗凝活性。在 III 期试验中，NOACs 与传统疗法相比，出血发生率相似或更低。在出血的情况下，有非特异性的逆转策略可用，而特定的逆转剂则是正在进行的试验的主题。本综述的目的是总结目前关于 NOACs 的知识，重点是围手术期的出血管理。
