Khan Yusra, Zaidi Syed Owais, Razak Bibi S, Zaki Mariann, Malik Bilal Haider
Pharmacy, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2020 Feb 16;12(2):e7007. doi: 10.7759/cureus.7007.
Vitamin K antagonists are being used in the last five decades as an effective anticoagulant. However, for the past few years, new oral anticoagulants (NOACs) have been introduced as newer anticoagulant agents, which are gradually replacing the previously used vitamin K antagonist. Yet, these agents have not fully replaced the use of warfarin and heparin. NOACs have few advantages over the vitamin K antagonist as they act on a specific factor of coagulation cascade rather than inhibiting the whole vitamin K synthesis. In this article, all the data has been searched electronically on PubMed and PRISMA guidelines were not followed. Instead, we used MOOSE statements and the data searched on PubMed was from articles published in the last five years. A total of 12,269 patients were observed;,out of which 64.19% had active cancer and 35.80% was observed as a control group comprised of both male or female participants. Approximately 61.14% were using NOACs, 42.83% were on warfarin, and 2.72% were on low-molecular-weight heparin (LMWH). The NOACs used in different patients were in the following percentages; edoxaban (6.81%), apixaban (5.28%), dabigatran (10.09%), and rivaroxaban (10.02%). The use of NOACs has been increasing day by day but these agents have not completely replaced the warfarin or heparin, because of some demerits associated with the use of warfarin and some conditions where these drugs should be avoided. All NOACs have either hepatic or renal clearance so the hepatic activity and creatinine clearance rate must be monitored before the start of NOACs. The drug interaction between anticancer drugs and NOACs is still not fully reported. The effects of NOACs in AF and VTE are therapeutically effective, but in oncology patients several other co-factors are also involved with the use of NOACs due to which, it is either contraindicated or in some cases dose adjustment is required. However, very little information has been collected and more investigation must be done in this perspective.
在过去的五十年里，维生素K拮抗剂一直被用作有效的抗凝剂。然而，在过去几年中，新型口服抗凝剂（NOACs）作为更新的抗凝药物被引入，它们正在逐渐取代以前使用的维生素K拮抗剂。然而，这些药物尚未完全取代华法林和肝素的使用。与维生素K拮抗剂相比，NOACs的优势在于它们作用于凝血级联反应的特定因子，而不是抑制整个维生素K的合成。在本文中，所有数据均通过在PubMed上进行电子搜索获得，且未遵循PRISMA指南。相反，我们使用了MOOSE声明，在PubMed上搜索的数据来自过去五年发表的文章。总共观察了12269名患者；其中64.19%患有活动性癌症，35.80%被作为由男性或女性参与者组成的对照组。大约61.14%的患者使用NOACs，42.83%的患者使用华法林，2.72%的患者使用低分子肝素（LMWH）。不同患者使用的NOACs比例如下：依度沙班（6.81%）、阿哌沙班（5.28%）、达比加群（10.09%）和利伐沙班（10.02%）。NOACs的使用一直在增加，但由于与华法林使用相关的一些缺点以及某些应避免使用这些药物的情况，这些药物尚未完全取代华法林或肝素。所有NOACs都有肝脏或肾脏清除途径，因此在开始使用NOACs之前必须监测肝脏活性和肌酐清除率。抗癌药物与NOACs之间的药物相互作用仍未得到充分报道。NOACs在房颤和静脉血栓栓塞症中的治疗效果显著，但在肿瘤患者中，由于使用NOACs还涉及其他一些因素，因此要么禁忌使用，要么在某些情况下需要调整剂量。然而，目前收集到的信息非常少，必须从这个角度进行更多的研究。
