Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea.
Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea.
Korean J Intern Med. 2023 Sep;38(5):583-594. doi: 10.3904/kjim.2023.035. Epub 2023 Sep 1.
In the last decade, non-vitamin K antagonist oral anticoagulants (NOACs), a new generation of OACs, were introduced to prevent thromboembolism in patients with atrial fibrillation. Although vitamin K-dependent anticoagulants have long been used as OACs, their inherent disadvantage of considerable bleeding complications has limited their use. NOACs demonstrate similar or superior clinical outcomes to those of warfarin. Although strict dose reduction criteria are recommended for NOACs, low-dose NOACs are frequently utilized, especially in Asian patients. Low-dose NOACs have shown clinical outcomes similar to those of warfarin in randomized controlled trials (RCTs) and real-world studies. However, off-label low-dose NOACs have shown inconsistent results compared with standard-dose NOACs and warfarin. Therefore, strict dose reduction criteria for NOACs should be followed until RCTs confirm the issues associated with NOAC underdosing.
在过去的十年中，新型口服抗凝剂（NOACs）作为新一代抗凝药物，已被引入用于预防房颤患者的血栓栓塞。尽管维生素 K 依赖性抗凝剂长期以来一直被用作 OAC，但它们具有相当大的出血并发症的固有缺点，限制了其使用。NOACs 与华法林相比具有相似或更优的临床结局。尽管建议对 NOAC 进行严格的剂量减少标准，但低剂量 NOAC 经常被使用，尤其是在亚洲患者中。低剂量 NOAC 已在随机对照试验（RCT）和真实世界研究中显示出与华法林相似的临床结局。然而，与标准剂量 NOAC 和华法林相比，非标签低剂量 NOAC 的结果不一致。因此，应遵循 NOAC 的严格剂量减少标准，直到 RCT 证实与 NOAC 剂量不足相关的问题。
