Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy -
Minerva Cardioangiol. 2020 Apr;68(2):98-109. doi: 10.23736/S0026-4725.20.05177-4.
Physical activity is worldwide recommended for its benefits on cardiovascular system. There is an increasing number of people of all ages that approach sport activity both as leisure time physical activity and as competitive sport. It is always more frequent the request even from older subjects and cardiac patients to be allowed to practice physical activity. Some problems could arise when these subjects present or develop pathologic conditions that require specific pharmacological treatment, in particular an anticoagulation therapy. This review focalizes on the management of oral anticoagulant therapy (OAT) in patients practicing sport activity, especially due to atrial fibrillation and deep vein thrombosis, which represent two highly prevalent conditions, particularly with increasing age. Official recommendations in this field may appear limiting for patients, forbidding in the majority of cases sports at risk of trauma and consequent bleeding. These recommendations still resent the heritage of the "traditional" management of OAT, mainly represented by vitamin-K antagonists (VKAs). The non-vitamin K antagonist oral anticoagulants, with their more favorable pharmacokinetic-pharmacodynamic profile compare to VKAs, may now represent an opportunity to modify the approach to sport activity in patients with an indication to OAT. This review of the literature deals with possible strategies to overcome the present limitations for OAT subjects willing to pursue a healthy lifestyle, that include sport activity, minimizing at the same time their risk of bleeding.
体育活动对心血管系统有益，因此在世界范围内被推荐。越来越多的不同年龄段的人将运动作为休闲时间的体育活动和竞技体育来进行。即使是老年患者和心脏病患者，也经常要求允许他们进行体育活动。当这些患者出现或患有需要特定药物治疗的病理状况时，可能会出现一些问题，特别是抗凝治疗。本篇综述的重点是管理接受体育活动的患者的口服抗凝治疗（OAT），特别是对于因心房颤动和深静脉血栓形成而接受治疗的患者，这两种情况都非常普遍，尤其是随着年龄的增长。该领域的官方建议对患者来说可能显得有限，因为这些建议禁止大多数情况下存在创伤和随后出血风险的运动。这些建议仍然代表了 OAT 的“传统”管理方法，主要是维生素 K 拮抗剂（VKAs）。与 VKAs 相比，新型的非维生素 K 拮抗剂口服抗凝剂具有更有利的药代动力学-药效学特征，现在可能为改变需要 OAT 的患者对体育活动的态度提供了机会。本篇文献综述探讨了可能的策略，以克服愿意追求健康生活方式（包括体育活动）的 OAT 患者的现有限制，同时将他们的出血风险降至最低。
