Khan Safeera, Krishnaswamy Ratna, Malik Bilal Haider, Islam Muhammad, Gupta Deepti, Mandal Shrawan Kumar, Rutkofsky Ian H
California Institute of Behavioral Neurosciences and Psychology, Fairfield, California, USA.
Mercer University, Macon GA, USA.
J Atr Fibrillation. 2019 Dec 31;12(4):2157. doi: 10.4022/jafib.2157. eCollection 2019 Dec.
Atrial fibrillation, a progressively rising global health problem, is also rising in Hemophiliacs due to an increase in life expectancy in them. While treating Hemophiliacs with AF, deciding eligibility, choosing the anticoagulant based on risk-benefit ratio are tough decisions for physicians to make. This review paper aims to explore and compare existing studies, reviews and consensus papers to assess the safety of different Novel Oral Anticoagulants (NOACS) in this population.
Thorough literature search was conducted on Pubmed using Atrial Fibrillation, Hemophilia A, Oral anticoagulants, stroke prevention, Dabigatran, factor Xa inhibitors as keywords separately and in combinations. Papers in English language only from the past 5 years were selected for review. After removing duplicate results, 80 papers were selected and after applying different exclusion criteria and according to relevance, 40 papers were finalized for review.
The keywords AF, Stroke prevention, oral anticoagulants, Hemophilia a, Factor Xa inhibitors and Dabigatran gave 24899, 13619, 8964, 3503, 2850, 2799 results, respectively. Combination keywords also showed some papers and out of short-listed 80 relevant papers 35 were finalized. Reviewing and analyzing these papers revealed no clinical trials in hemophiliacs with AF in the past 5 years and 5 clinical trials comparing NOACs with Warfarin in general population. Rest were systematic reviews, consensus papers and meta-analyses on management in this group. A few compared these drugs for AF in the general population but not specifically in Hemophiliacs and others. consensus papers developed suggestions for management and showed that NOACs are superior to Warfarin but need individual evaluation in Hemophiliacs with AF.
Patients with Hemophilia can also have thrombo-embolism despite their bleeding tendency and NOACs are a better option in them because of less need for monitoring, no food interactions and fewer drug interactions. This comparative review emphasized the need for more work to develop proper guidelines for thrombo-prophylaxis management in this specific group.
心房颤动是一个在全球范围内日益严重的健康问题，由于血友病患者预期寿命的增加，其在血友病患者中的发病率也在上升。在治疗患有房颤的血友病患者时，确定其适用性、根据风险效益比选择抗凝剂，对医生来说是艰难的决策。这篇综述文章旨在探索和比较现有研究、综述及共识文件，以评估不同新型口服抗凝剂（NOACs）在该人群中的安全性。
在Pubmed上进行全面的文献检索，分别使用“心房颤动”“甲型血友病”“口服抗凝剂”“中风预防”“达比加群”“Xa因子抑制剂”作为关键词，并进行组合检索。仅选择过去5年的英文论文进行综述。在去除重复结果后，筛选出80篇论文，再根据不同的排除标准并依据相关性，最终确定40篇论文进行综述。
关键词“房颤”“中风预防”“口服抗凝剂”“甲型血友病”“Xa因子抑制剂”和“达比加群”分别产生了24899、13619、8964、3503、2850、2799条结果。组合关键词也显示出一些论文，在入围的80篇相关论文中，最终确定了35篇。对这些论文进行回顾和分析发现，在过去5年中没有关于血友病合并房颤患者的临床试验，有5项关于在普通人群中比较NOACs与华法林的临床试验。其余的是关于该组管理的系统综述、共识文件和荟萃分析。一些研究在普通人群中比较了这些药物对房颤的疗效，但并非专门针对血友病患者，其他一些研究则是共识文件，对管理提出了建议，表明NOACs优于华法林，但在患有房颤的血友病患者中需要进行个体评估。
血友病患者尽管有出血倾向，但也可能发生血栓栓塞，NOACs对他们来说是更好的选择，因为其监测需求较少、不存在食物相互作用且药物相互作用较少。这一比较性综述强调需要开展更多工作，为这一特定人群制定适当的血栓预防管理指南。
