Ageno Walter, Caramelli Bruno, Donadini Marco Paolo, Girardi Laura, Riva Nicoletta
Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Lancet Haematol. 2024 Dec;11(12):e938-e950. doi: 10.1016/S2352-3026(24)00281-3. Epub 2024 Oct 18.
Over the last decade, the advent of direct oral anticoagulants (DOACs) has rapidly changed the landscape of anticoagulation. In the early 2010s, DOACs became widely available for stroke prevention in atrial fibrillation and the treatment of venous thromboembolism. About 10 years later, approximately two-thirds of patients requiring oral anticoagulant treatment were receiving a DOAC. The results of several post-marketing studies consistently confirmed the findings of phase 3 clinical trials, and research has focused on new areas of development, with heterogeneous results. A role for DOACs has emerged for patients with peripheral artery disease and other challenging conditions, such as cancer-associated thrombosis, unusual-site venous thromboembolism, and end-stage renal disease. Conversely, clinical trials showed that DOACs were not efficacious in patients with valvular atrial fibrillation, mechanical heart valves, embolic strokes of undetermined source, or antiphospholipid syndrome. In this Review, we discuss the impact of DOACs in clinical practice over the last decade, new areas under development, and practical issues in the management of these drugs.
在过去十年中，直接口服抗凝剂（DOACs）的出现迅速改变了抗凝治疗的格局。在21世纪10年代初，DOACs广泛用于心房颤动的卒中预防及静脉血栓栓塞的治疗。大约10年后，约三分之二需要口服抗凝治疗的患者接受了DOACs治疗。多项上市后研究结果一致证实了3期临床试验的结果，并且研究已聚焦于新的研发领域，但结果各异。对于外周动脉疾病及其他具有挑战性的情况（如癌症相关血栓形成、非寻常部位静脉血栓栓塞和终末期肾病）的患者，DOACs已显示出一定作用。相反，临床试验表明，DOACs在瓣膜性心房颤动、机械心脏瓣膜、不明来源栓塞性卒中或抗磷脂综合征患者中无效。在本综述中，我们讨论了DOACs在过去十年临床实践中的影响、正在研发的新领域以及这些药物管理中的实际问题。
