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基层医疗中的口服抗凝治疗。

Oral anticoagulation in primary care.

作者信息

Altirriba J, Aparicio P

机构信息

Anticoagulation in Primary Care Task Force, Societat Catalana de Medicina Famíliar i Comunitària (CAMFIC).

出版信息

Rev Esp Sanid Penit. 2017 Jun;19(1):19-34. doi: 10.4321/S1575-06202017000100004.

Abstract

Oral anticoagulant therapy is currently widespread in the population and primary care plays an important role in its control in Spain. Younger populations, such as those in prisons, often require this treatment for reasons other than atrial fibrillation, often in relation to valvular or congenital or acquired hypercoagulability situations. The possibility of obtaining the INR by portable coagulometers has allowed primary care physicians to tackle the indication of this therapy and the control of these patients in coordination with haematology services. The emergence of new therapeutic alternatives (Dabigatran, Rivaroxaban, Apixaban and Edoxaban, the so called "ACOD") has permitted the expansion of options for oral anticoagulation in some cases, since they do not require systematic monitoring of their effect and interact with far fewer drugs than their predecessors, although there are still restrictions by the health authorities on their widespread use. This article reviews the different indications of oral anticoagulant therapy according to the new recommendations as well as the clinical scenarios in which it should be used.

摘要

口服抗凝治疗目前在人群中广泛应用,在西班牙,初级保健在其管理中发挥着重要作用。较年轻的人群,如监狱中的人群,经常因房颤以外的原因需要这种治疗,通常与瓣膜性、先天性或获得性高凝状态有关。通过便携式凝血仪获取国际标准化比值(INR)的可能性,使初级保健医生能够在与血液学服务部门协调的情况下,处理这种治疗的适应症及对这些患者的管理。新治疗替代药物(达比加群、利伐沙班、阿哌沙班和依度沙班,即所谓的“非维生素K拮抗剂口服抗凝药”)的出现,在某些情况下扩大了口服抗凝的选择范围,因为它们不需要系统监测其效果,且与药物相互作用的情况比其前代药物少得多,尽管卫生当局对其广泛使用仍有限制。本文根据新建议回顾了口服抗凝治疗的不同适应症以及应使用该治疗的临床情况。

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