Tripodi Armando, Clerici Marigrazia, Scalambrino Erica, Agosti Pasquale, Bucciarelli Paolo, Peyvandi Flora
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.
Mediterr J Hematol Infect Dis. 2024 Mar 1;16(1):e2024027. doi: 10.4084/MJHID.2024.027. eCollection 2024.
Oral anticoagulants are widely used to treat or prevent cardiovascular diseases in millions of patients worldwide. They are the drugs of choice for stroke prevention and systemic embolism in patients with non-valvular atrial fibrillation and prosthetic heart valves, as well as for treatment/prevention of venous thromboembolism. Oral anticoagulants include vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). The hemostasis laboratory plays a crucial role in the management of treated patients, spanning from dose adjustment based on laboratory testing that applies to VKAs to the measurement of drug concentrations in special situations that apply to DOACs. This article aims to overview how the hemostasis laboratory can help clinicians manage patients on oral anticoagulants. Special interest is devoted to the international normalized ratio, used to manage patients on VKAs and to the measurement of DOAC concentrations, for which the role of the laboratory is still not very well defined, and most interferences of DOACs with some of the most common hemostatic parameters are not widely appreciated.
口服抗凝剂在全球数百万患者中被广泛用于治疗或预防心血管疾病。它们是预防非瓣膜性心房颤动和人工心脏瓣膜患者中风及全身性栓塞，以及治疗/预防静脉血栓栓塞的首选药物。口服抗凝剂包括维生素K拮抗剂（VKAs）和直接口服抗凝剂（DOACs）。止血实验室在接受治疗的患者管理中起着至关重要的作用，范围从基于适用于VKAs的实验室检测进行剂量调整，到适用于DOACs的特殊情况下药物浓度的测量。本文旨在概述止血实验室如何帮助临床医生管理服用口服抗凝剂的患者。特别关注用于管理服用VKAs患者的国际标准化比值，以及DOAC浓度的测量，实验室在这方面的作用仍不太明确，而且DOACs对一些最常见止血参数的大多数干扰尚未得到广泛认识。
