Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055 Saint-Etienne, France; INSERM, CIC-1408, CHU Saint-Etienne, F-42055 Saint-Etienne, France.
Internal Medicine and Vascular Medicine Department, Charles Nicolles Hospital, Rouen, France.
Blood Rev. 2018 Jul;32(4):272-279. doi: 10.1016/j.blre.2018.01.002. Epub 2018 Apr 20.
Direct oral anticoagulants (DOACs) are indicated in the treatment and prevention of venous thromboembolism (VTE). However, the use of DOACs in unusual VTE, including cerebral venous thrombosis (CVT) and splanchnic venous thrombosis (SVT), and in patients with biological thrombophilia including minor thrombophilia (Factor V Leiden and prothrombin G20210A), major innate thrombophilia (protein C and S deficiency, and antithrombin) and major acquired thrombophilia (antiphospholipid syndrome [APS]), remains controversial due to the paucity of available data. There are some reports of DOACs use in the initial treatment or long-term maintenance of patients with either CVT or SVT, but their efficacy remains unclear. The efficacy of DOACs may be suitable in patients with biological minor or major thrombophilia. The use of DOACs for the long-term maintenance of patients with APS is more contentious. Randomized clinical trials, which are currently underway, should offer definitive insight into the efficacy and safety profiles of DOACs in these patient populations.
直接口服抗凝剂（DOACs）适用于静脉血栓栓塞症（VTE）的治疗和预防。然而，由于缺乏可用数据，DOACs 在不常见的 VTE（包括脑静脉血栓形成[CVT]和内脏静脉血栓形成[SVT]）和伴有生物性血栓形成倾向的患者（包括小血栓形成倾向[因子 V Leiden 和凝血酶原 G20210A]、大先天性血栓形成倾向[蛋白 C 和 S 缺乏以及抗凝血酶]和大获得性血栓形成倾向[抗磷脂综合征（APS]））中的应用仍存在争议。有一些关于 DOACs 在 CVT 或 SVT 患者初始治疗或长期维持治疗中的应用的报告，但它们的疗效尚不清楚。DOACs 的疗效可能适用于伴有生物性小或大血栓形成倾向的患者。APS 患者长期使用 DOACs 更具争议。目前正在进行的随机临床试验应该能够明确 DOACs 在这些患者人群中的疗效和安全性特征。
