Iapichino Giacomo E, Bianchi Paolo, Ranucci Marco, Baryshnikova Ekaterina
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Semin Thromb Hemost. 2017 Jun;43(4):423-432. doi: 10.1055/s-0037-1599157. Epub 2017 Mar 27.
Direct oral anticoagulants (DOACs) exert similar anticoagulant effects to vitamin K antagonists and are increasingly used worldwide. Nevertheless, an evidence-based approach to patients receiving DOACs when any unplanned urgent surgery or bleeding (either spontaneous or traumatic) occurs is still missing. In this review, we investigate the role of point-of-care coagulation tests when other, more specific tests are not available. Indeed, thromboelastography and activated clotting time can detect dabigatran-induced coagulopathy, while their accuracy is limited for apixaban and rivaroxaban, mostly in cases of low drug plasma concentrations. These tests can also be used to guide the reversal of DOAC-induced coagulopathy providing a quick, before-and-after picture in case of therapeutic use of hemostatic compounds.
直接口服抗凝剂（DOACs）具有与维生素K拮抗剂相似的抗凝作用，在全球范围内的使用越来越广泛。然而，当发生任何计划外的紧急手术或出血（自发性或外伤性）时，针对接受DOACs治疗的患者，仍缺乏基于证据的处理方法。在本综述中，我们研究了在无法进行其他更特异检测时，即时凝血检测的作用。实际上，血栓弹力图和活化凝血时间能够检测达比加群引起的凝血病，而对于阿哌沙班和利伐沙班，其准确性有限，主要是在药物血浆浓度较低的情况下。这些检测还可用于指导DOAC引起的凝血病的逆转，在使用止血化合物进行治疗时提供快速的前后对比情况。
