Li Ang, Lopes Renato D, Garcia David A
Division of Hematology, Department of Medicine, University of Washington Medical Center, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA.
Division of Cardiology, Department of Medicine, Duke University Medical Center, Box 3850, 2400 Pratt Street, Room 0311, Terrace Level, Durham, NC 27705, USA.
Hematol Oncol Clin North Am. 2016 Oct;30(5):1053-71. doi: 10.1016/j.hoc.2016.05.003. Epub 2016 Aug 9.
Direct oral anticoagulants (DOACs) have been approved for the treatment of venous thromboembolism and atrial fibrillation based on randomized controlled trials (RCTs) of direct comparisons with vitamin K antagonists. Despite having more than 100,000 patients enrolled, safety and efficacy are debated in selected populations. Although DOACs are reviewed as a class of anticoagulant, pharmacokinetic differences exist such that different medications may be beneficial in distinct clinical settings. Synthesizing available evidence based on phase III RCTs, post hoc subgroup analyses, and pooled metaanalyses, this review provides an overview of DOACs and scrutinizes individual differences in their applications for the special populations.
直接口服抗凝剂（DOACs）已基于与维生素K拮抗剂直接比较的随机对照试验（RCTs）被批准用于治疗静脉血栓栓塞症和心房颤动。尽管纳入了超过10万名患者，但在特定人群中，其安全性和有效性仍存在争议。虽然DOACs作为一类抗凝剂进行审查，但存在药代动力学差异，因此不同药物在不同临床环境中可能有益。本综述基于III期RCTs、事后亚组分析和汇总荟萃分析综合现有证据，概述了DOACs，并审视了它们在特殊人群应用中的个体差异。
