Preventive strategies against bleeding due to nonvitamin K antagonist oral anticoagulants.
Preventive strategies against bleeding due to nonvitamin K antagonist oral anticoagulants.
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DOI：
10.1155/2014/616405
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发表时间：
2014
影响因子：
--
通讯作者：
Mullier F
中科院分区：
文献类型：
--
作者：
Lessire S;Dincq AS;Douxfils J;Devalet B;Nicolas JB;Spinewine A;Larock AS;Dogné JM;Gourdin M;Mullier F
达比加群酯（DE）、利伐沙班和阿哌沙班是非维生素K拮抗剂口服抗凝剂（NOAC），已在临床试验中与现有抗凝剂（华法林和依诺肝素）在预防和治疗血栓形成事件的几种适应症中进行了比较。尽管对患者进行了仔细选择和控制，但所有NOAC均出现出血事件。与华法林相比，NOAC的颅内出血风险降低，阿哌沙班和DE（110 mg BID）的任何部位大出血风险降低。与华法林相比，利伐沙班和DE显示胃肠道大出血的风险增加。制定策略以最大限度地降低出血风险至关重要，因为在临床实践中报告了严重的眼睑炎，并且目前没有特定的解毒剂。本文综述了以下预防措施：改进适当的处方，识别可改变的出血危险因素，调整NOAC的剂量，处理漏服剂量以及坚持转换，桥接和麻醉程序。
Dabigatran etexilate (DE), rivaroxaban, and apixaban are nonvitamin K antagonist oral anticoagulants (NOACs) that have been compared in clinical trials with existing anticoagulants (warfarin and enoxaparin) in several indications for the prevention and treatment of thrombotic events. All NOACs presented bleeding events despite a careful selection and control of patients. Compared with warfarin, NOACs had a decreased risk of intracranial hemorrhage, and apixaban and DE (110 mg BID) had a decreased risk of major bleeding from any site. Rivaroxaban and DE showed an increased risk of major gastrointestinal bleeding compared with warfarin. Developing strategies to minimize the risk of bleeding is essential, as major bleedings are reported in clinical practice and specific antidotes are currently not available. In this paper, the following preventive approaches are reviewed: improvement of appropriate prescription, identification of modifiable bleeding risk factors, tailoring NOAC's dose, dealing with a missed dose as well as adhesion to switching, bridging and anesthetic procedures.