Traditional Internal Medicine Residency Program, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Section of Hematology, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Clin Chest Med. 2018 Sep;39(3):583-593. doi: 10.1016/j.ccm.2018.04.010.
The mainstay of treatment of venous thromboembolism (VTE) is anticoagulation. Direct oral anticoagulants (DOAC) have revolutionized anticoagulation management, although their efficacy and safety in specialized populations such as antiphospholipid syndrome, advanced renal disease, cancer thrombosis, and geriatric patients remain uncertain. Concerns about bleeding risks of DOACs persist despite reassuring data in the literature and the development of specific antidotes. In this article, the authors present an overview of the basic pharmacology of DOACs and discuss their use in acute VTE, secondary VTE prevention, and specialized VTE patient populations and discuss therapeutic monitoring and reversal in the event of major bleeding.
静脉血栓栓塞症（VTE）的主要治疗方法是抗凝。直接口服抗凝剂（DOAC）彻底改变了抗凝管理，尽管它们在抗磷脂综合征、晚期肾病、癌症血栓形成和老年患者等特殊人群中的疗效和安全性仍不确定。尽管文献中有令人安心的数据，并且开发了特定的解毒剂，但人们仍然担心 DOAC 的出血风险。在本文中，作者概述了 DOAC 的基本药理学，并讨论了它们在急性 VTE、继发性 VTE 预防以及特殊 VTE 患者人群中的应用，并讨论了在发生大出血时的治疗监测和逆转。
