当直接口服抗凝剂不应该成为标准治疗时:JACC最先进的技术审查
Antoine Bejjani1, Candrika D Khairani2, Ali Assi3
1Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
直接口服抗凝剂 (DOAC) 是许多疾病的首选药物,但有证据表明它们并不总是优于其他治疗方法. 本综述详细介绍了DOAC何时有效,何时使用需要谨慎.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 心血管医学 心血管医学
- 血液学 血液学 血液学
背景情况:
- 直接口服抗凝剂 (DOAC) 已成为维生素K对抗剂的首选替代品,用于预防中风,治疗心房动和静脉血栓栓塞.
- 然而,针对特定患者群体和疾病,它们的最佳使用和与已知的治疗方法相比的比较有效性仍在研究中.
研究的目的:
- 提供基于证据的随机对照试验 (RCT) 关于DOACs的疗效和安全性的综述.
- 划出临床场景,其中DOACs是有益的,其中它们不被视为标准护理,以及需要进一步研究的地方.
主要方法:
- 对直接口服抗凝剂发表的随机对照试验进行系统审查和基于证据的分析.
- 根据已证明的疗效,缺乏净益,不确定的疗效/安全以及未来研究领域来对发现进行分类.
主要成果:
- 在大多数患者中,DOAC证明了心房动中风预防和静脉血栓栓塞治疗的有效性和安全性.
- 对于机械心脏门,血栓性抗脂综合征和风湿性心脏病相关的心房动,DOAC可能不如标准护理那么有效或安全.
- 对左心室血栓,导管相关深静脉血栓,脑静脉鼻血栓以及末期病患者的疗效尚不确定.
结论:
- 虽然DOAC在许多常见的适应症中具有优势,但它们的使用并不普遍优于现有疗法.
- 关于DOACs的临床决定必须考虑患者的特定情况,包括膜心脏病,抗脂综合征和功能.
- 进一步的研究是必不可少的,以澄清DOACs在复杂的血栓和血栓状况中的作用.
更多相关视频
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
07:08Assessment of the Anticoagulant and Anti-inflammatory Properties of Endothelial Cells Using 3D Cell Culture and Non-anticoagulated Whole Blood
Published on: September 5, 2017
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
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...
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Antihypertensive Drugs: Direct Renin Inhibitors
Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
