直接口服抗凝剂的实验室测试
1UK NEQAS (Blood Coagulation), Sheffield, UK. christopher.reilly-stitt@nhs.net.
Handbook of experimental pharmacology
|December 15, 2025
概括
直接口服抗凝剂 (DOAC) 提供方便,但在特定情况下需要进行实验室测试. 检测对准确性,质量控制和管理与其他血液静止测试的潜在干扰至关重要.
科学领域:
- 药理学和临床实验室科学 药理学和临床实验室科学
- 血液静止和血栓形成
- 药物监测 药物监测 药物监测
背景情况:
- 直接口服抗凝剂 (DOAC),包括达比加特兰和XA因子抑制剂,已经改变了抗凝剂治疗.
- 与华法林等传统抗凝剂相比,DOACs具有优势,例如可预测的药理动力学和最小的药物/食物相互作用.
- 对于DOAC,通常不需要进行常规的实验室监测,从而简化了患者管理.
研究的目的:
- 审查DOACs的药理学,临床应用和实验室评估.
- 概述用于DOAC量化的可用测定方法,并讨论其原理.
- 突出实验室评估在特定临床场景中的重要性,并解决测试干扰问题.
主要方法:
- 关于DOAC药理学,临床使用和实验室测试的文献综述.
- 对LC-MS/MS,色素抗Xa和基于ecarin的测定等量化方法的分析原理的讨论.
- 检查DOAC对常规凝血测试和其他血液静止测试的影响,包括干扰缓解策略.
主要成果:
- 液体染色学-双重质谱法 (LC-MS/MS) 是DOAC量化的黄金标准,染色体抗Xa和稀释血时间 (DTT) 测试是常见的替代方案.
- DOAC对常规凝血测试 (PT,APTT,TT) 有可变的影响,需要药物特定的校准器和验证.
- DOACs可以干扰其他静血试验,但活性炭基试剂可以中和这种干扰.
结论:
- 尽管DOACs具有优势,但在特定的临床情况下,如出血,血栓形成或紧急手术,对DOACs的实验室测试仍然至关重要.
- 质量保证 (IQC和EQA) 对于准确和可重复的DOAC测定结果至关重要,符合ISO 15189:2022标准.
- DOAC在很大程度上取代了华法林治疗心房动和静脉血栓栓塞等疾病,但实验室监测是安全和有效的患者护理的关键.
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