Monagle Sarah, Eikelboom John W, Ng Kuan H, Bhagirath Vinai C
Population Health Research Institute, Hamilton, Canada.
Monash University, Melbourne, Australia.
Future Cardiol. 2017 Mar;13(2):153-159. doi: 10.2217/fca-2016-0070. Epub 2017 Feb 13.
Direct oral anticoagulants (DOACs) are effective in preventing and treating venous thromboembolism, and preventing stroke in atrial fibrillation. Until recently, there has been no specific reversal agent for DOACs. Now, a specific antidote for the direct thrombin inhibitor, dabigatran has been approved for use, and antidotes for factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) are being developed. We review the evidence for currently used and emerging reversal strategies, and discuss possible clinical implications, including increased prescription of DOACs, use of DOACs in clinical situations previously felt to pose too great a risk of bleeding, and use of reversal agents beyond currently approved indications.
直接口服抗凝剂（DOACs）在预防和治疗静脉血栓栓塞以及预防房颤患者中风方面有效。直到最近，还没有针对DOACs的特异性逆转剂。现在，直接凝血酶抑制剂达比加群的一种特异性解毒剂已获批使用，并且针对Xa因子抑制剂（利伐沙班、阿哌沙班和依度沙班）的解毒剂也正在研发中。我们回顾了当前使用的和新出现的逆转策略的证据，并讨论了可能的临床意义，包括DOACs处方的增加、在以前认为出血风险过高的临床情况下使用DOACs以及在目前批准的适应症之外使用逆转剂。
