Fiore Marco, Maraolo Alberto Enrico, Chiodini Paolo, Cerchione Claudio, Gentile Ivan, Borgia Guglielmo, Pace Maria Caterina
Department of Anaesthesiological, Surgical & Emergency Sciences, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy.
Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", 80131, Naples, Italy.
Cardiovasc Hematol Disord Drug Targets. 2017;17(2):105-110. doi: 10.2174/1871529X17666170703115545.
Approximately 3% of Tuberculosis (TB) patients have a venous thromboembolic events (VTE). The use of Vitamin K antagonists (VKAs), as anticoagulant, in patients receiving anti TB antimicrobials is often complicated by drug interactions, especially with rifampicin. These patients require frequent monitoring of the International Normalized Ratio (INR), and it is reported that warfarin can not achieve a therapeutic INR. In such cases, abruptly stopping the rifampicin once the course of anti TB antimicrobials is not completed is potentially hazardous. The most recent alternative to prevent thrombotic episodes by using oral agents is represented by novel oral anticoagulants (NOAs) an important breakthrough since they do not require strict laboratory monitoring, frequent dosing adjustments, or dietary restrictions; moreover, they and they are linked with far fewer drug-drug interactions.
We have performed a Systematic Review to retrieve information about studies that have assessed the effect of NOAs administered in combination with anti TB antimicrobials in order to investigate if NOAs could be used in TB patients with VTE that do not achieve a therapeutic INR with VKAs.
The MEDLINE and Google Scholar databases were screened from the inception to 5th of February 2017, using two search strategies: the first one was antimicrobials AND novel oral anticoagulants; the second was antibiotics AND novel oral anticoagulants.
1011 titles were identified on PubMed and Google Scholar published from the inception to February 5, 2017, of these 17 studies were included in the qualitative synthesis Conclusion: No published data were found that properly assessed the effect of NOAs administered in combination with anti TB antimicrobials. Further studies are needed to establish the safety of NOAs in this clinical scenario. In the meanwhile, a viable alternative to VKAs, in order to prevent complications of VTE related to TB, may be represented by Low Molecular Weight Heparin (LMWH), notwithstanding the limitation of the parental route of administration.
约3%的结核病（TB）患者会发生静脉血栓栓塞事件（VTE）。在接受抗结核抗菌药物治疗的患者中，使用维生素K拮抗剂（VKA）作为抗凝剂时，常常因药物相互作用而变得复杂，尤其是与利福平的相互作用。这些患者需要频繁监测国际标准化比值（INR），并且据报道华法林无法达到治疗性INR。在这种情况下，一旦抗结核抗菌药物疗程未完成就突然停用利福平可能具有危险性。使用口服药物预防血栓形成事件的最新替代方法是新型口服抗凝剂（NOA），这是一项重要突破，因为它们不需要严格的实验室监测、频繁的剂量调整或饮食限制；此外，它们与药物相互作用的情况要少得多。
我们进行了一项系统评价，以检索有关评估NOA与抗结核抗菌药物联合使用效果的研究信息，以便调查NOA是否可用于VKA无法达到治疗性INR的TB合并VTE患者。
从数据库建立至2017年2月5日，对MEDLINE和谷歌学术数据库进行筛选，使用两种检索策略：第一种是抗菌药物与新型口服抗凝剂；第二种是抗生素与新型口服抗凝剂。
在PubMed和谷歌学术上，从数据库建立至2017年2月5日共识别出1011篇标题，其中17项研究纳入了定性分析。结论：未发现有发表的数据能恰当评估NOA与抗结核抗菌药物联合使用的效果。需要进一步研究来确定NOA在这种临床情况下的安全性。同时，尽管存在经肠外途径给药的局限性，但低分子肝素（LMWH）可能是VKA的一种可行替代药物，用于预防与TB相关的VTE并发症。
