Enríquez Andrés, Baranchuk Adrian, Corbalán Ramón
Departamento de Cardiología, Hospital Guillermo Grant Benavente, Concepción, Chile.
Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
Rev Med Chil. 2019;147(1):73-82. doi: 10.4067/S0034-98872019000100073.
Direct oral anticoagulants (DOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban have at least comparable efficacy as vitamin K antagonists along with a better safety profile, reflected by a lower incidence of intracranial hemorrhage. Specific reversal agents have been developed in recent years. Namely, idarucizumab, a specific antidote for dabigatran, is currently approved in most countries. Andexanet, which reverses factor Xa inhibitors, has been recently approved by the FDA, and ciraparantag, a universal antidote targeted to reverse all DOACs, is still under investigation. In this review we provide an update on the pharmacology of DOACs, the risk of hemorrhagic complications associated with their use, the measurement of their anticoagulant effect and the reversal strategies in case of DOAC-associated bleeding.
直接口服抗凝剂（DOACs），包括直接凝血酶抑制剂达比加群以及直接因子Xa抑制剂利伐沙班、阿哌沙班和依度沙班，其疗效至少与维生素K拮抗剂相当，且安全性更佳，表现为颅内出血发生率较低。近年来已开发出特异性逆转剂。具体而言，达比加群的特异性解毒剂艾达凝血酶单抗目前在大多数国家已获批准。可逆转因子Xa抑制剂的安多凝血素最近已获美国食品药品监督管理局（FDA）批准，而一种旨在逆转所有DOACs的通用解毒剂环帕兰特仍在研究中。在本综述中，我们提供了关于DOACs药理学、使用DOACs相关出血并发症风险、其抗凝效果的测量以及DOAC相关出血时的逆转策略的最新信息。
