口服抗凝治疗。
Oral Anticoagulation.
机构信息
Department of Cardiology, Angiology and Intensive Care Medicine (Department of Internal Medicine I), University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
出版信息
Dtsch Arztebl Int. 2018 Nov 16;115(46):776-783. doi: 10.3238/arztebl.2018.0776.
BACKGROUND
Much new evidence on oral anticoagulation has come to light in recent years. Non-vitamin-K-dependent oral anti- coagulants (NOAC) have been developed and have been introduced into clinical practice. In this review, we present the current state of the evidence on anticoagulation for various indications with vitamin K antagonists (VKA) and with NOAC.
METHODS
This review is based on pertinent articles retrieved by a selective search in PubMed (search terms: anticoagulation, atrial fibrillation, prosthetic valve, thrombosis, pulmonary embolism) and on specialty society recommendations and relevant guidelines from the years 2000-2018.
RESULTS
The main indications for oral anticoagulation are atrial fibrillation, venous thromboembolism, and status post heart valve replacement. In patients with atrial fibrillation and without valvular heart disease, anticoagulation is recommended for men with a CHA2DS2-VASc score ≥ 1 and for women with a score ≥ 2. NOAC for this indication are associated with a marginally lower rate of stroke than VKA (3.5% vs. 3.8%, number needed to treat [NNT] = 333) as well as a lower rate of major hemorrhage (5.1% vs. 6.2%, NNT = 91). NOAC are contraindicated for patients with mechanical heart valves. Anticoagulation with VKA can be predictably antagonized. Among the various types of NOAC, the anticoagulant effect of dabigatran can be safely antagonized with an antidote; no specific antidote is yet available for apixaban, rivaroxaban, or edoxaban.
CONCLUSION
The evidence base for anticoagulation over a time frame of several years is inadequate at present, and direct comparative data for the different types of NOAC are not yet available.
背景
近年来，出现了大量关于口服抗凝的新证据。非维生素 K 依赖性口服抗凝剂（NOAC）已被开发并引入临床实践。在本综述中，我们介绍了目前维生素 K 拮抗剂（VKA）和 NOAC 在各种适应证下抗凝的证据状况。
方法
本综述基于在 PubMed 中进行的选择性搜索中检索到的相关文章（搜索词：抗凝、心房颤动、人工瓣膜、血栓形成、肺栓塞），以及专业学会建议和 2000 年至 2018 年的相关指南。
结果
口服抗凝的主要适应证为心房颤动、静脉血栓栓塞和心脏瓣膜置换术后。在没有瓣膜性心脏病的心房颤动患者中，对于 CHA2DS2-VASc 评分≥1 的男性和评分≥2 的女性，建议抗凝。对于该适应证，NOAC 与 VKA 相比，卒中发生率略低（3.5%比 3.8%，需要治疗的人数[NNT]为 333），大出血发生率也较低（5.1%比 6.2%，NNT 为 91）。机械心脏瓣膜患者禁用 NOAC。VKA 的抗凝作用可被预测性拮抗。在各种类型的 NOAC 中，达比加群的抗凝作用可被安全拮抗的解毒剂拮抗；阿哌沙班、利伐沙班或依度沙班尚无特定解毒剂。
结论
目前，抗凝的证据基础在几年的时间内是不足的，并且不同类型的 NOAC 之间还没有直接比较的数据。
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