Martin A-C, Godier A, Smadja D M, Mauge L, Fischer A-M
Service de cardiologie, service de santé des armées, hôpital d'instruction des armées Percy, 92025 Clamart, France; Inserm UMR-S 1140, faculté de pharmacie, université Paris-Descartes, 75006 Paris, France.
Inserm UMR-S 1140, faculté de pharmacie, université Paris-Descartes, 75006 Paris, France; Service d'anesthésie réanimation, fondation Adolphe-de-Rothschild, 75019 Paris, France.
Transfus Clin Biol. 2017 Sep;24(3):154-159. doi: 10.1016/j.tracli.2017.05.019. Epub 2017 Jun 30.
Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.
直接口服抗凝剂（DOAC）适用于房颤患者的卒中预防以及静脉血栓栓塞的预防和治疗。与任何抗凝剂一样，它们都有出血风险。DOAC所致出血的管理具有挑战性。达比加群的解毒剂依达赛珠单抗目前已可使用，是治疗策略的一部分，而抗Xa因子药物的解毒剂正在研发中。尽管其逆转DOAC的疗效尚不确定，但已有人提出使用活化或未活化的凝血酶原浓缩物。我们建议更新DOAC相关出血的管理方法，纳入依达赛珠单抗的可获得性以及DOAC浓度测量的关键地位。
