University of Iowa Hospitals and Clinics, Iowa City, United States.
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
Anaesthesiol Intensive Ther. 2021;53(5):440-449. doi: 10.5114/ait.2021.110608.
During the last decade, utilization of direct oral anticoagulants (DOACs) has increased due to their pharmacokinetic profile and the fact that they are non-inferior to warfarin in the prevention of stroke in patients with atrial fibrillation, as well as for the treatment of venous thromboembolism. However, there are few studies about their use in critically ill patients. This article aims to review available evidence on the use of DOACs in the indicated conditions and anticoagulant management of medical or surgical patients receiving DOAC before intensive care unit (ICU) admission. The rapidly changing pathophysiology and heterogeneous nature of critically ill patients combined with limited evidence often leads to a high degree of individualization of DOAC regimens in ICU patients. This article is the second part of the narrative review series on the use of DOACs in ICU patients, focusing on current "Clinical evidence". "Applied pharma-cology" has been described in the first part.
在过去的十年中，直接口服抗凝剂（DOACs）的应用有所增加，这是由于它们的药代动力学特性以及在预防房颤患者中风方面与华法林相当，同时也可用于治疗静脉血栓栓塞症。然而，关于它们在危重症患者中的应用的研究较少。本文旨在回顾在特定情况下使用 DOACs 的现有证据，以及在入住重症监护病房（ICU）之前接受 DOAC 治疗的内科或外科患者的抗凝管理。危重症患者的病理生理学变化迅速且性质多样，再加上证据有限，这常常导致 ICU 患者的 DOAC 方案需要高度个体化。本文是关于 ICU 患者使用 DOACs 的叙述性综述系列的第二部分，重点介绍当前的“临床证据”。第一部分介绍了“应用药理学”。
