Tapson Victor F
a Venous Thromboembolism and Pulmonary Vascular Disease Research Program, Clinical Research , Women's Guild Lung Institute, Cedars-Sinai Medical Center , Los Angeles , CA , USA.
Hosp Pract (1995). 2016 Aug;44(3):164-72. doi: 10.1080/21548331.2016.1210471. Epub 2016 Jul 29.
Pulmonary embolism (PE) is a leading cause of mortality worldwide. Recognizing PE and administering anticoagulants can significantly improve patient outcomes by reducing mortality rates and preventing recurrent events. For more than 50 years, standard therapy has involved parenteral anticoagulation followed by long-term therapy with the vitamin K antagonist warfarin. However, management of warfarin therapy is challenging due to its narrow therapeutic range and interactions with genetic and environmental factors. Direct oral anticoagulants (DOACs) have been developed to simplify anticoagulation and avoid the concerns associated with warfarin. DOACs are administered at a fixed dosage without routine monitoring and have few drug interactions. In recent years, DOACs have received FDA approval for the treatment of acute deep venous thrombosis (DVT) and PE based on the results of well-conducted clinical trials. This review discusses approaches to the diagnosis and treatment of PE and the use of DOACs as an alternative to warfarin treatment for the management of the disease. While many of the indications for DOACs and concepts discussed apply to both DVT and PE, our focus will be acute PE.
肺栓塞（PE）是全球范围内主要的死亡原因之一。识别肺栓塞并给予抗凝剂可通过降低死亡率和预防复发事件显著改善患者预后。五十多年来，标准治疗方法一直是先进行胃肠外抗凝，然后使用维生素K拮抗剂华法林进行长期治疗。然而，由于华法林的治疗窗狭窄以及与遗传和环境因素的相互作用，其治疗管理具有挑战性。直接口服抗凝剂（DOACs）已被开发出来以简化抗凝治疗并避免与华法林相关的问题。DOACs以固定剂量给药，无需常规监测，且药物相互作用较少。近年来，基于良好开展的临床试验结果，DOACs已获得美国食品药品监督管理局（FDA）批准用于治疗急性深静脉血栓形成（DVT）和肺栓塞。本综述讨论了肺栓塞的诊断和治疗方法，以及DOACs作为华法林治疗替代方案用于该疾病管理的情况。虽然DOACs的许多适应证和所讨论的概念适用于DVT和肺栓塞，但我们的重点将是急性肺栓塞。
