McRae Hannah L, Militello Leah, Refaai Majed A
Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, Hemostasis and Thrombosis Unit, University of Rochester Medical Center, Rochester, NY 14642, USA.
Biomedicines. 2021 Mar 6;9(3):262. doi: 10.3390/biomedicines9030262.
In the past six decades, heparin and warfarin were the primary anticoagulants prescribed for treatment and prophylaxis of venous thromboembolism worldwide. This has been accompanied by extensive clinical knowledge regarding dosing, monitoring, and reversal of these anticoagulants, and the resources required to do so have largely been readily available at small and large centers alike. However, with the advent of newer oral and parenteral anticoagulants such as low molecular weight heparins, factor Xa inhibitors, and direct thrombin inhibitors in recent years, new corresponding practice guidelines have also emerged. A notable shift in the need for monitoring and reversal agents has evolved as well. While this has perhaps streamlined the process for physicians and is often desirable for patients, it has also left a knowledge and resource gap in clinical scenarios for which urgent reversal and monitoring is necessary. An overview of the currently available anticoagulants with a focus on the guidelines and available tests for anticoagulant monitoring will be discussed in this article.
在过去的六十年里，肝素和华法林一直是全球范围内用于治疗和预防静脉血栓栓塞的主要抗凝剂。与此同时，关于这些抗凝剂的给药、监测和逆转，已有广泛的临床知识，而且无论大小中心，进行这些操作所需的资源大多都很容易获得。然而，近年来随着新型口服和肠外抗凝剂的出现，如低分子量肝素、Xa因子抑制剂和直接凝血酶抑制剂，相应的新实践指南也应运而生。在监测和逆转剂的需求方面也发生了显著变化。虽然这可能简化了医生的操作流程，而且患者通常也希望如此，但在需要紧急逆转和监测的临床情况下，这也造成了知识和资源的缺口。本文将概述目前可用的抗凝剂，重点讨论抗凝监测的指南和可用检测方法。
