在治疗抗凝固剂之间进行转换:临床医生指南将患者从或转换为DOAC治疗
Benilde Cosmi1,2, Michelangelo Sartori2
1Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Expert review of cardiovascular therapy
|November 4, 2024
概括
切换直接口服抗凝剂 (DOACs) 需要仔细考虑患者因素和潜在风险. 基于证据的指导是有限的,需要进一步研究最佳抗凝剂过渡策略.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 临床实践指南 临床实践指南
- 抗凝血管理 抗凝血管理
背景情况:
- 过渡抗凝药疗法,包括直接口服抗凝药 (DOACs),是常见的临床场景.
- 目前用于切换抗凝剂的做法通常基于有限的证据和外推数据.
研究的目的:
- 审查过渡到或从直接口服抗凝剂 (DOAC) 的条件和方法.
- 为了确定基于证据的指导方针对抗凝血剂切换的漏洞.
主要方法:
- 在PubMed,谷歌学者和UpToDate进行了全面的文献搜索,截至2024年3月.
- 进行了叙述性审查,分析了切换抗凝剂和当前过渡策略的条件.
主要成果:
- 现有的随机临床试验很少,只有两个专注于从经过良好管理的维生素K抗剂治疗转向DOACs.
- 影响过渡的关键因素包括血栓塞栓/出血风险,/肝功能,药物相互作用,不良事件,脆弱性,患者偏好和成本.
- 目前的过渡方法主要来自临床试验数据和产品信息.
结论:
- 由于缺乏可靠的证据,关于最佳抗凝剂切换策略的重大不确定性仍然存在.
- 进一步的研究至关重要,以建立基于证据的指导方针,从DOAC过渡到DOAC,解决特定的临床情景和最佳方法.
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