Dabi Alok, Koutrouvelis Aristides P
Neurosciences Critical Care Program, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA.
Department of Anesthesiology, Anesthesiology Critical Care Medicine, Surgical and Trauma Intensive Care Unit, Galveston, TX 77555, USA.
Crit Care Res Pract. 2018 Jul 4;2018:4907164. doi: 10.1155/2018/4907164. eCollection 2018.
Direct oral anticoagulants (DOACs) are a new class of anticoagulants that directly inhibit either thrombin or factor Xa in the coagulation cascade. They are being increasingly used instead of warfarin or other vitamin K antagonists (VKAs). Adverse side effects of DOACs may result in hemorrhagic complications, including life-threatening intracranial hemorrhage (ICH), though to a much lesser degree than VKAs. Currently there are relatively limited indications for DOACS but their usage is certain to expand with the availability of their respective specific reversal agents. Currently, only idarucizumab (antidote for dabigatran) has been United States Food and Drug Administration- (FDA-) approved, but others (andexanet- and ciraparantag) may be approved in near future, and the development and availability of such reversal agents have the potential to dramatically change the current anticoagulant use by providing reversal of multiple oral anticoagulants. Until all the DOACs have FDA-approved reversal agents, the treatment of the dreaded side effects of bleeding is challenging. This article is an attempt to provide an overview of the management of hemorrhage, especially ICH, related to DOAC use.
直接口服抗凝剂（DOACs）是一类新型抗凝剂，可直接抑制凝血级联反应中的凝血酶或Xa因子。它们正越来越多地被用于替代华法林或其他维生素K拮抗剂（VKAs）。DOACs的不良副作用可能导致出血并发症，包括危及生命的颅内出血（ICH），尽管其发生率远低于VKAs。目前DOACs的适应证相对有限，但随着各自特异性逆转剂的出现，其应用肯定会扩大。目前，只有艾达司珠单抗（达比加群的解毒剂）已获得美国食品药品监督管理局（FDA）批准，但其他药物（安多昔单抗和环帕罗司他）可能在不久的将来获得批准，而且这类逆转剂的研发和应用有可能通过提供多种口服抗凝剂的逆转方法，极大地改变当前抗凝剂的使用方式。在所有DOACs都有FDA批准的逆转剂之前，治疗令人恐惧的出血副作用具有挑战性。本文旨在概述与DOAC使用相关的出血管理，尤其是ICH的管理。
