Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges.
Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges.
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DOI：
10.1161/jaha.120.017559
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发表时间：
2020-07-07
影响因子：
5.4
通讯作者：
A Warden B
中科院分区：
文献类型：
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作者：
Chen A;Stecker E;A Warden B
直接口服抗凝剂（DOACs）已迅速成为有吸引力的替代长期存在的抗凝护理标准，维生素K拮抗剂。doac可用于预防和治疗多种心血管疾病。自2010年首次获批以来，doac已成为领先的治疗方案，为临床医生和患者提供了更有效、更安全、更方便的治疗选择。随着doac作用的扩大，临床医生面临着与适当的药物、治疗持续时间和特殊人群使用有关的日益复杂的决策。本综述将提供DOAC的概述，并作为临床医生在常见的具有挑战性的情况下优化DOAC使用的实用参考。讨论的主题包括(1)适当的适应症；(2)用于有特定合并症的患者；(3)监测参数；(4)抗凝治疗方案之间的过渡；(5)重大药物相互作用；(6)成本考虑。
Direct oral anticoagulants (DOACs) have quickly become attractive alternatives to the long‐standing standard of care in anticoagulation, vitamin K antagonist. DOACs are indicated for prevention and treatment of several cardiovascular conditions. Since the first approval in 2010, DOACs have emerged as leading therapeutic alternatives that provide both clinicians and patients with more effective, safe, and convenient treatment options in thromboembolic settings. With the expanding role of DOACs, clinicians are faced with increasingly complex decisions relating to appropriate agent, duration of treatment, and use in special populations. This review will provide an overview of DOACs and act as a practical reference for clinicians to optimize DOAC use among common challenging scenarios. Topics addressed include (1) appropriate indications; (2) use in patients with specific comorbidities; (3) monitoring parameters; (4) transitioning between anticoagulant regimens; (5) major drug interactions; and (6) cost considerations.