Kamath Suneel D, McMahon Brandon J
Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Semin Intervent Radiol. 2016 Jun;33(2):122-31. doi: 10.1055/s-0036-1582124.
The novel oral anticoagulants (NOACs) represent a major advance in the treatment of patients with nonvalvular atrial fibrillation and venous thromboembolism (VTE). They have several advantages over vitamin-K antagonists such as warfarin, including more predictable pharmacokinetics and improved safety, particularly with fatal bleeding and intracranial hemorrhage. However, several issues remain surrounding the use of NOACs in certain subpopulations and with the approach to reversal. The periprocedural management of anticoagulation with these relatively new agents can also present several challenges. This article reviews the basic pharmacology, efficacy, and safety of these drugs. Several populations at higher risk for complications with use of NOACs are discussed, including those undergoing procedures. Finally, several target-specific reversal agents have either received FDA approval or likely will be approved in the near future; these agents and their roles in the approach to anticoagulation reversal will also be discussed.
新型口服抗凝药（NOACs）是治疗非瓣膜性心房颤动和静脉血栓栓塞（VTE）患者的一项重大进展。与华法林等维生素K拮抗剂相比，它们具有多个优势，包括药代动力学更可预测以及安全性更高，尤其是在致命性出血和颅内出血方面。然而，在某些亚人群中使用NOACs以及逆转方法方面仍存在一些问题。使用这些相对较新的药物进行围手术期抗凝管理也会带来一些挑战。本文综述了这些药物的基本药理学、疗效和安全性。讨论了使用NOACs发生并发症风险较高的几类人群，包括接受手术的人群。最后，几种靶向特异性逆转剂已获得美国食品药品监督管理局（FDA）批准或近期可能获批；还将讨论这些药物及其在抗凝逆转方法中的作用。
