Direct oral anticoagulant drugs (DOAC).
Direct oral anticoagulant drugs (DOAC).
复制标题
直接口服抗凝药物（DOAC）。
DOI：
10.1016/j.jcrs.2015.12.002
复制
发表时间：
2016
影响因子：
2.8
通讯作者：
Dan Lindfield
中科院分区：
文献类型：
--
作者：
R. Blum;Dan Lindfield
开发了直接口服抗凝剂作为华法林的替代品。它们提供可预测和固定剂量的抗凝治疗，而无需血液检测监测。1可用的新型口服抗凝剂包括达比加群（泰毕全）、利伐沙班（拜瑞妥）和阿哌沙班（Eliquis）。这些药物直接抑制活化的凝血因子。达比加群抑制因子IIa（凝血酶）;阿哌沙班和利伐沙班抑制因子Xa（图1）。相比之下，华法林抑制维生素K途径并影响因子II、VII、IX、X以及蛋白质S和C。2. Warcadine是一种难以临床使用的药物，有时甚至是危险的药物，因为其治疗范围很窄（表1）。许多饮食，药理学和遗传因素可以影响其安全性和有效性。3直接口服抗凝剂不太容易受到这些影响，因此提供更安全，更有效的抗凝治疗，而无需常规监测。Idarucizumab是达比加群的逆转剂，最近在美国和英国获得批准。4然而，目前没有有效的逆转剂可用于利伐沙班或阿哌西班，尽管有几种正在开发中。1到目前为止，没有研究涉及与直接口服抗凝剂相关的白内障手术中出血并发症的风险。相比之下，华法林在白内障手术背景下进行了广泛研究，并且始终显示在治疗范围内使用时，不会增加威胁视力的并发症的风险，如脉络膜/脉络膜上腔出血、后囊膜破裂、前房出血、球后出血或球周出血。最大的研究5包括
Direct oral anticoagulants were developed as alternatives to warfarin. They provide predictable and fixed-dose anticoagulation without the need for blood-test monitoring. 1 Available novel oral anticoagulants include dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). These drugs directly inhibit activated clotting factors. Dabigatran inhibits factor IIa (thrombin); apixaban and rivaroxaban inhibit factor Xa (Figure 1). In contrast, warfarin inhibits the vitamin-K pathway and affects factors II, VII, IX, X, and proteins S and C. 2 Warfarin is a difficult and sometimes dangerous drug to use clinically due to its narrow therapeutic range (Table 1). Numerous dietary, pharmacologic, and genetic factors can influence its safety and efficacy. 3 Direct oral anticoagulants are less susceptible to these influences and therefore provide safer and more effective anticoagulation without the need for routine monitoring. Idarucizumab, a reversal agent for dabigatran, was recently approved in the United States and Great Britain. 4 However, no effective reversal agent is currently available for rivaroxaban or apixiban although several are in development. 1To date, no study has addressed the risk for hemorrhagic complications during cataract surgery related to direct oral anticoagulants. In contrast, warfarin has been extensively studied in the context of cataract surgery and has consistently shown no increased risk for sight-threatening complications such as choroidal/suprachoroidal hemorrhage, posterior capsule rupture, hyphema, retrobulbar hemorrhage, or peribulbar hemorrhage when used in the therapeutic range. The largest study 5 comprised