Department of Haematology, Northern Health, Epping, Victoria, Australia.
Australian Centre for Blood Diseases, Melbourne, Victoria, Australia.
Semin Thromb Hemost. 2018 Apr;44(3):261-266. doi: 10.1055/s-0038-1637750. Epub 2018 Mar 20.
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs. Therefore, challenges to the thrombosis community remain to determine patients who would benefit from long-term anticoagulation in the DOAC era. Here, the authors review the current literature on risks and benefits of DOACs and their potential role in long-term VTE thromboprophylaxis as well as in current risk assessment models. The increasing use of DOACs, led by their convenience of use and generally lower bleeding rates, calls for a reevaluation of the current models as the benefits of long-term anticoagulation may begin to outweigh risks and inconvenience associated with their predecessors.
直接口服抗凝剂 (DOAC) 的出现彻底改变了卒中预防和静脉血栓栓塞症 (VTE) 治疗/预防中的抗凝管理。临床试验和二次真实世界数据表明，DOAC 与维生素 K 拮抗剂相比具有相似的疗效，在某些情况下具有更好的出血安全性。加上患者便利性的好处，这使得长期抗凝的风险效益比向有利于抗凝的方向倾斜。然而，目前的 VTE 风险评估模型是基于维生素 K 拮抗剂的，并未考虑 DOAC 的新范式。因此，血栓形成领域仍面临挑战，需要确定在 DOAC 时代哪些患者从长期抗凝中受益。在这里，作者回顾了 DOAC 的风险和益处及其在长期 VTE 血栓预防以及当前风险评估模型中的潜在作用的现有文献。由于 DOAC 使用方便，出血率通常较低，其使用越来越多，这要求重新评估当前的模型，因为长期抗凝的益处可能开始超过与其前代药物相关的风险和不便。
