四因子前列红素复合物缩剂与安德克萨尼特α为直接口服抗凝药逆转作用
Journal of the American Pharmacists Association : JAPhA
|November 12, 2023
概括
安德克萨内特α (AA) 和4因子前素复合缩物 (4F-PCC) 在直接口服抗凝血剂出血方面表现出类似的静血疗效和安全性. 两种药物都没有显示出死亡率或血栓事件的显著差异.
科学领域:
- 血液学 血液学 血液学
- 药理学 药理学是指药理学的学科.
- 关键护理医学 关键护理医学
背景情况:
- 与直接口服抗凝剂 (DOAC) 相关的大型出血的最佳逆转药物仍在研究中.
- 从历史上看,建议使用4因子前列红素复合缩物 (4F-PCC),但现在安德克萨内特阿尔法 (AA) 是指南中首选的药物.
- 有限的比较文献需要评估AA与4F-PCC的静血疗效和安全性.
研究的目的:
- 为了比较安德xanet alfa (AA) 和4因子前列红素复合物缩物 (4F-PCC) 的静血疗效和安全性,在服用DOAC时出现严重出血的患者中.
主要方法:
- 一个多中心的回顾性图表审查包括了与DOAC相关的大型出血的成年患者,他们接受了4F-PCC或AA.
- 排除标准确保了对DOAC相关出血事件的全剂量逆转的关注.
- 主要结局:在24小时内静血疗效. 二次结果:死亡率,停留时间,需要手术/血液制品. 安全结果:血栓事件.
主要成果:
- 该研究包括4F-PCC组的99名患者和AA组的84名患者.
- 在4F-PCC组的69.7%和AA组的75% (P=0.927) 观察到静血疗效.
- 住院死亡率发生在4F-PCC组的20.2%和AA组的11.9%中. 在两组中,血栓事件发生在7.1%的患者中.
结论:
- 在4F-PCC和AA之间,对于与DOAC相关的大型出血,血静疗效没有发现显著差异.
- 在两种逆转药物之间,住院死亡率和血栓事件的发生率是可比的.
- 这些发现表明,尽管目前的指南偏好,但在管理与DOAC相关的大型出血时,可以考虑这两种药物.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
Anticoagulant Drugs: Low-Molecular-Weight Heparins
719
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
719
Venous Thrombosis III: Interprofessional Care
10
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10
Masking and Demasking Agents
2.5K
EDTA titrations may necessitate masking and demasking agents to temporarily protect a particular metal ion in a mixture from the EDTA reaction. These agents facilitate the sequential analysis of the metal ions by forming stable complexes with some—but not all—metal ions during certain steps.
There are many masking agents, such as cyanide, fluoride, triethanolamine, thiourea, and 2,3-bis(sulfanyl)propan-1-ol (formerly 2,3-dimercapto-1-propanol), with the masking agent chosen based on...
There are many masking agents, such as cyanide, fluoride, triethanolamine, thiourea, and 2,3-bis(sulfanyl)propan-1-ol (formerly 2,3-dimercapto-1-propanol), with the masking agent chosen based on...
2.5K
Extrinsic and Intrinsic Pathways of Hemostasis
8.0K
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
8.0K
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
535
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
535


