Alhabeeb Waleed, Tash Adel, Aljedai Ahmed, Morsy Ayman, Khaliel Feras, Alhazmi Iman, AlSheef Mohammed, Arafah Mohammed, Alshammeri Owayed, AlAhmari Saeed
Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
National Heart Center, Saudi Health Council, Riyadh, Saudi Arabia.
J Saudi Heart Assoc. 2025 Mar 9;37(2):2. doi: 10.37616/2212-5043.1423. eCollection 2025.
Direct oral anticoagulants (DOACs) have emerged as non-inferior and effective alternatives to traditional anticoagulants in managing thromboembolic risks associated with various cardiovascular conditions. This position statement by the Saudi Heart Association (SHA) aims to provide guidance on the use of DOACs in the context of cardiovascular disease, particularly patients with arterial and venous thrombosis.
A multidisciplinary panel of experts reviewed current evidence and international guidelines on DOACs, considering the local healthcare context in Saudi Arabia. The statement addresses the initiation, maintenance, interruption, and re-initiation of DOAC therapy across different patient populations.
DOACs are effective alternatives to traditional anticoagulants with a comparable or lower risk of bleeding and no requirement for frequent monitoring, making them more convenient for patients. It is important to regularly assess stroke risk (CHA2DS2-VASc score) and bleeding risk (HAS-BLED score) before initiating DOAC therapy and during the course of treatment, particularly in patients with changing clinical conditions. Specific factors warrant careful consideration for the use of DOACs in special patient populations. Recommendations are therefore provided for dosing adjustments in renal and hepatic impairment, alongside considerations for patients in different clinical scenarios such as those undergoing surgery or with malignancies.
DOACs represent a valuable option for clinicians owing to their efficacy, safety and convenience compared to traditional anticoagulants. DOACs should be used based on individualized patient assessment, particularly regarding bleeding risk, stroke risk, and other comorbidities and clinical factors that may affect clinical outcomes. Adherence to the recommendations and guidance provided in this SHA statement is needed to enhance patient care and outcomes in Saudi Arabia.
在管理与各种心血管疾病相关的血栓栓塞风险方面，直接口服抗凝剂（DOACs）已成为传统抗凝剂的非劣效且有效的替代品。沙特心脏协会（SHA）的这份立场声明旨在为心血管疾病背景下，特别是动脉和静脉血栓形成患者使用DOACs提供指导。
一个多学科专家小组审查了关于DOACs的当前证据和国际指南，并考虑了沙特阿拉伯当地的医疗环境。该声明涉及不同患者群体中DOAC治疗的起始、维持、中断和重新起始。
DOACs是传统抗凝剂的有效替代品，出血风险相当或更低，且无需频繁监测，对患者来说更方便。在开始DOAC治疗前以及治疗过程中，定期评估卒中风险（CHA2DS2-VASc评分）和出血风险（HAS-BLED评分）很重要，尤其是在临床情况发生变化的患者中。在特殊患者群体中使用DOACs时，特定因素需要仔细考虑。因此，针对肾功能和肝功能损害时的剂量调整提供了建议，同时也考虑了不同临床场景下的患者，如接受手术或患有恶性肿瘤的患者。
与传统抗凝剂相比，DOACs因其有效性、安全性和便利性，对临床医生来说是一个有价值的选择。应根据个体化的患者评估使用DOACs，特别是关于出血风险、卒中风险以及可能影响临床结局的其他合并症和临床因素。需要遵循本SHA声明中提供的建议和指导，以提高沙特阿拉伯的患者护理水平和治疗效果。
