Lucà Fabiana, Oliva Fabrizio, Abrignani Maurizio Giuseppe, Di Fusco Stefania Angela, Parrini Iris, Canale Maria Laura, Giubilato Simona, Cornara Stefano, Nesti Martina, Rao Carmelo Massimiliano, Pozzi Andrea, Binaghi Giulio, Maloberti Alessandro, Ceravolo Roberto, Bisceglia Irma, Rossini Roberta, Temporelli Pier Luigi, Amico Antonio Francesco, Calvanese Raimondo, Gelsomino Sandro, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo
Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy.
Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy.
J Clin Med. 2023 Sep 13;12(18):5955. doi: 10.3390/jcm12185955.
It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.
众所周知，直接口服抗凝剂（DOACs）是心房颤动（AF）和静脉血栓栓塞（VTE）抗凝策略的基石，应优先于维生素K拮抗剂（VKAs），因为它们在降低血栓栓塞风险方面优于或不劣于VKAs，且颅内出血（IH）风险较低。此外，许多因素，如较少的药代动力学相互作用和较少的监测需求，都有利于这种治疗策略。尽管DOACs是更合适的选择，但在临床实践中仍应考虑几个问题，包括药物相互作用（DDIs）、转换为其他抗栓治疗、术前和术后阶段，以及在慢性肾衰和肝衰患者以及癌症患者中的使用。此外，DOACs的依从性似乎仍然不理想。本叙述性综述旨在为DOAC处方提供实用指南，并解决具有挑战性的情况。
