The use of direct oral anticoagulants in inherited thrombophilia
The use of direct oral anticoagulants in inherited thrombophilia
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DOI：
10.1007/s11239-016-1428-2
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发表时间：
2017-01-01
影响因子：
4
通讯作者：
Thomason, Angela R.
中科院分区：
文献类型：
--
作者：
Skelley, Jessica W.;White, C. Whitney;Thomason, Angela R.
结合文献对直接口服抗凝剂（DOAC）在遗传性血栓形成倾向中的应用进行综述。MEDLINE、国际药物文摘和Google Scholar检索（1970年至2016年5月）的病例报告、病例系列、回顾性队列或临床试验，使用关键词：蛋白C缺乏、蛋白S缺乏、抗凝血酶缺乏、活化蛋白C抵抗、凝血因子V Leiden、高凝、NOAC、达比加群、阿哌沙班、利伐沙班、贝曲沙班、依度沙班、Xa抑制剂，直接凝血酶抑制剂。结果仅限于英文文章。选择并评价了评价DOAC用于遗传性血栓形成倾向相关高凝状态的临床研究。血栓形成倾向是血栓形成的一种倾向，主要表现为静脉血栓栓塞。遗传性血栓形成倾向的原因包括抗凝血酶缺乏、蛋白质C和S缺乏以及凝血因子V Leiden突变。许多血栓形成倾向患者接受抗凝治疗以进行VTE的一级或二级预防，历史上为华法林或肝素产品。基于其药理活性，DOAC已被认为是传统药物的潜在替代品。病例报告和临床试验的事后分析表明，遗传性血栓形成倾向和VTE患者的结果呈阳性。在遗传性血栓形成倾向中，DOAC的使用报告了阳性结果。临床医生需要进一步的强有力的研究来做出明确的决策。
To review the use of the direct oral anticoagulant (DOAC) agents in inherited thrombophilia based on the literature. MEDLINE, International Pharmaceutical Abstracts, and Google Scholar searches (1970-May 2016) were conducted for case reports, case series, retrospective cohorts, or clinical trials using the key words: protein C deficiency, protein S deficiency, antithrombin deficiency, activated protein C resistance, Factor V Leiden, hypercoagulable, NOACs, dabigatran, apixaban, rivaroxaban, betrixaban, edoxaban, Xa inhibitor, direct thrombin inhibitor. Results were limited to English-only articles. Clinical studies evaluating the use of DOACs for hypercoagulable states related to inherited thrombophilia were selected and evaluated. Thrombophilia, a predisposition to thrombosis, manifests predominantly as venous thromboembolism. Causes of inherited thrombophilia include antithrombin deficiency, deficiencies of proteins C and S, and Factor V Leiden mutation. Many patients with thrombophilia receive anticoagulant therapy for primary or secondary prevention of VTE, historically either warfarin or a heparin product. DOAC's have been considered as potential alternatives to traditional agents based on their pharmacologic activity. Case reports and a post-hoc analysis of a clinical trial have indicated positive results in patients with inherited thrombophilia and VTE. Positive results have been reported for the use of DOACs in inherited thrombophilia. Further robust studies are needed for definitive decision making by clinicians.