Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
Department of Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA.
Chest. 2019 Sep;156(3):604-618. doi: 10.1016/j.chest.2019.05.025. Epub 2019 Jun 25.
The direct-acting oral anticoagulants (DOACs) have been increasingly used over vitamin K antagonists in recent years because they do not require monitoring and have an immediate anticoagulation effect. In general, DOACs have exhibited a better safety profile and noninferiority for prophylaxis and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation compared with vitamin K antagonists in the non-ICU population; whether this finding holds true in patients who are critically ill remains unknown. The current review addresses the role of DOACs in special ICU populations, use of these agents for VTE prophylaxis, perioperative management of DOACs, drug monitoring, and potential drug interactions of DOACs in critically ill patients. Adverse events and available reversal agents for DOACs are also discussed.
近年来，直接口服抗凝剂（DOAC）在临床上的应用日益增多，超过了维生素 K 拮抗剂，因为它们不需要监测，并且具有即时抗凝作用。一般来说，与维生素 K 拮抗剂相比，DOAC 具有更好的安全性和非劣效性，可用于预防和治疗非 ICU 人群中的静脉血栓栓塞症（VTE）和预防房颤患者的中风；但这一发现是否适用于重症患者仍不清楚。目前的综述探讨了 DOAC 在特殊 ICU 人群中的作用、这些药物在 VTE 预防中的应用、DOAC 的围手术期管理、药物监测以及 DOAC 在重症患者中的潜在药物相互作用。还讨论了 DOAC 的不良事件和可用的逆转剂。
