Kunk Paul R, Brown Jacqueline, McShane Melissa, Palkimas Surabhi, Gail Macik B
Division of Hematology-Oncology, Department of Medicine, University of Virginia Health System, PO Box 800716, Charlottesville, VA, 22908-0716, USA.
Division of Hematology, Department of Clinical Pharmacy, University of Virginia Health System, Charlottesville, VA, USA.
J Thromb Thrombolysis. 2017 Jan;43(1):79-85. doi: 10.1007/s11239-016-1420-x.
Direct oral anticoagulants have been shown safe and effective in the treatment of pulmonary emboli and deep vein thrombi. Their role in the treatment of patients with hypercoagulability is uncertain. We designed a retrospective exploratory analysis of all patients with definite heparin induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS) that were treated with either apixaban or rivaroxaban from September 2011 through November 2015. Patients were reviewed for several clinico-pathologic features, including efficacy and safety. 23 patients were identified (12 patients with HIT and 11 patients with APS). Sixteen patients (70 %) were treated with apixaban and seven patients (30 %) were treated with rivaroxaban over a median follow up of 7 months (range 2-39). Zero patients developed recurrent thrombi. Two patients being treated for HIT developed major bleeding leading to discontinuation of all anticoagulation. Therefore, apixaban and rivaroxaban appear safe and effective for treatment of patients with HIT and APS in this small retrospective cohort and should be considered on an individual basis for patients who refuse, fail or are intolerant of warfarin. There were no sources of funding.
直接口服抗凝剂已被证明在治疗肺栓塞和深静脉血栓方面安全有效。它们在治疗高凝性患者中的作用尚不确定。我们对2011年9月至2015年11月期间接受阿哌沙班或利伐沙班治疗的所有确诊肝素诱导的血小板减少症（HIT）和抗磷脂综合征（APS）患者进行了一项回顾性探索性分析。对患者的几个临床病理特征进行了评估，包括疗效和安全性。共确定了23例患者（12例HIT患者和11例APS患者）。在中位随访7个月（范围2 - 39个月）期间，16例患者（70%）接受了阿哌沙班治疗，7例患者（30%）接受了利伐沙班治疗。无患者发生复发性血栓。2例接受HIT治疗的患者发生了大出血，导致所有抗凝治疗中断。因此，在这个小的回顾性队列中，阿哌沙班和利伐沙班对于治疗HIT和APS患者似乎是安全有效的，对于拒绝、使用华法林失败或不耐受华法林的患者应个体化考虑使用。本研究无资金来源。
