Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital Foundation NHS Trust, London, UK.
Institute of Pharmaceutical Science, King's College London, London, UK.
Br J Haematol. 2019 Mar;184(6):912-924. doi: 10.1111/bjh.15756. Epub 2019 Jan 29.
The availability of direct oral anticoagulants (DOACs) has led to a paradigm shift in the field of anticoagulation, with DOACs increasingly being prescribed for patients in preference to vitamin K antagonists and low molecular weight heparin. Despite good experience with the use of these agents at fixed doses, there are clinical scenarios where monitoring is recommended. Data from phase III studies of the DOACs and small real-world studies suggest a relationship between DOAC concentration and clinical events. The DOACs have differing impacts on the common tests of haemostasis and it is important that clinicians are familiar with the sensitivity of the reagents used in their laboratory to individual DOACs. The specific DOAC drug concentrations can be assayed in the laboratory, when required, to guide appropriate clinical decision-making. Studies from the real world with sufficient numbers evaluating the association of DOAC concentrations with outcomes should be a research priority in order to understand if we could do better through dose individualisation.
直接口服抗凝剂（DOAC）的出现改变了抗凝领域的治疗模式，DOAC 的应用日益广泛，逐渐取代了维生素 K 拮抗剂和低分子肝素。尽管固定剂量的 DOAC 应用经验丰富，但在某些临床情况下，仍建议进行监测。III 期 DOAC 研究和小型真实世界研究的数据表明，DOAC 浓度与临床事件之间存在关联。DOAC 对常见止血检测有不同的影响，临床医生应熟悉实验室中用于检测 DOAC 的试剂的敏感性。必要时，可在实验室检测特定 DOAC 的药物浓度，以指导临床做出适当的决策。为了了解是否可以通过个体化剂量来提高疗效，应优先开展具有足够数量评估 DOAC 浓度与结局相关性的真实世界研究。
