Steinberg Benjamin A, Washam Jeffrey B
Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT.
Department of Internal Medicine, Duke Heart Center, Duke University Medical Center, Durham, NC.
Trends Cardiovasc Med. 2017 Nov;27(8):567-572. doi: 10.1016/j.tcm.2017.06.012. Epub 2017 Jun 19.
The development of nonvitamin K antagonist oral anticoagulants (NOACs) has been a major advance in therapy for patients requiring oral anticoagulation, particularly for long-term indications such as stroke prevention in atrial fibrillation (AF). The NOACs are generally easier to dose and manage due to less heterogeneity of effect across individuals and fewer drug and food interactions, compared with warfarin. However, the treatment effect of NOACs may vary based on important patient characteristics, particularly renal function. Therefore, the package inserts for these drugs have dosing recommendations for patients with impaired kidney function, which are frequently but not always based on evidence from large-scale, randomized, clinical trials. Furthermore, there is evidence that NOAC dosing inconsistent with the regulatory labeling may be associated with adverse clinical outcomes. This review discusses the evidence supporting the current NOAC dosing, current dosing practices, associated outcomes, and gaps in knowledge regarding use of NOACs in patients with AF.
非维生素K拮抗剂口服抗凝药（NOACs）的研发是需要口服抗凝治疗患者治疗领域的一项重大进展，特别是对于长期适应症，如心房颤动（AF）的卒中预防。与华法林相比，由于个体间效应异质性较小且药物与食物相互作用较少，NOACs通常更容易给药和管理。然而，NOACs的治疗效果可能因重要的患者特征而异，特别是肾功能。因此，这些药物的包装说明书针对肾功能受损患者有给药建议，这些建议通常但并非总是基于大规模随机临床试验的证据。此外，有证据表明，NOAC给药与监管标签不一致可能与不良临床结局相关。本综述讨论了支持当前NOAC给药的证据、当前的给药实践、相关结局以及房颤患者使用NOACs的知识空白。
