新型口服抗凝药不良反应研究进展
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摘要
新型口服抗凝药是华法林及其他维生素K拮抗剂的一类替代药物。相较于维生素K拮抗剂,新型口服抗凝药起效快、半衰期短、无需实验室监测、不易受食物及药物影响,主要用于非瓣膜性心房颤动患者缺血性卒中的预防。新型口服抗凝药在临床应用时间较短,报道的最为主要的不良反应为出血,现对近年来涉及新型口服抗凝药主要不良反应的研究进行综述,为临床安全应用提供参考。
Novel oral anticoagulants(NOACs) are alternative medicines for warfarin and other vitamin-K antagonists.NOACs offer potential advantages over VKAs,such as rapid onset of action,short half-life,do not require regular monitoring and fewer drug and food interactions.NOACs are used for the prevention of ischemic stroke in patients with non-valvular atrial fibrillation.NOACs have short application time,and the major adverse reaction reported is gastric hemorrhage.This article reviews recent studies on the adverse reaction of NOACs and provides a reference for clinical drug use.
Novel oral anticoagulants(NOACs) are alternative medicines for warfarin and other vitamin-K antagonists.NOACs offer potential advantages over VKAs,such as rapid onset of action,short half-life,do not require regular monitoring and fewer drug and food interactions.NOACs are used for the prevention of ischemic stroke in patients with non-valvular atrial fibrillation.NOACs have short application time,and the major adverse reaction reported is gastric hemorrhage.This article reviews recent studies on the adverse reaction of NOACs and provides a reference for clinical drug use.
引文
[1]Qamar A,Vaduganathan M,Greenberger NJ,et al.Oral anticoagulation in patients with liver disease[J].J Am Coll Cardiol,2018,71(19):2162-2175.
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[3]Ruff CT,Giugliano RP,Braunwald E,et al.Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation:a meta-analysis of randomised trials[J].Lancet,2014,383(9921):955-962.
[4]Larsen TB,Skjth F,Nielsen PB,et al.Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation:propensity weighted nationwide cohort study[J].BMJ,2016,353:i3189.
[5]Renda G,Ricci F,Giugliano RP,et al.Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease[J].J Am Coll Cardiol,2017,69(11):1363-1371.
[6]Lip GYH,Collet JP,Caterina R,et al.Antithrombotic therapy in atrial fibrillation associated with valvular heart disease:a joint consensus document from the European Heart Rhythm Association(EHRA)and European Society of Cardiology Working Group on Thrombosis,endorsed by the ESC Working Group on Valvular Heart Disease,Cardiac Arrhythmia Society of Southern Africa(CAS-SA),Heart Rhythm Society(HRS),Asia Pacific Heart Rhythm Society(APHRS),South African Heart(SA Heart)Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología(SOLEACE)[J].Europace,2017,19(11):1757-1758.
[7]Pan KL,Singer DE,Ovbiagele B,et al.Effects of non-vitamin K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and valvular heart disease-a systematic review and meta-analysis[J].J Am Heart Assoc,2017,6(7).pii:e005835.
[8]Gibson CM,Mehran R,Bode C,et al.Prevention of bleeding in patients with atrial fibrillation undergoing PCI[J].N Engl J Med,2016,375(25):2423-2434.
[9]Cannon CP,Bhatt DL,Oldgren J,et al.Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation[J].N Engl J Med,2017,377(16):1513-1524.
[10]Del-Carpio Munoz F,Gharacholou SM,Munger TM,et al.Meta-analysis of renal function on the safety and efficacy of novel aral anticoagulants for atrial fibrillation[J].Am J Cardiol,2016,117(1):69-75.
[11]Qamar A,Bhatt DL.Stroke prevention in atrial fibrillation in patients with chronic kidney disease[J].Circulation,2016,133(15):1512-1515.
[12]Chokesuwattanaskul R,Thongprayoon C,Tanawuttiwat T,et al.Safety and efficacy of apixaban versus warfarin in patients with end stage renal disease:metaanalysis[J].Pacing Clin Electrophysiol,2018,41(6):627-634.
[13]Pastori D,Lip GYH,Farcomeni A,et al.Incidence of bleeding in patients with atrial fibrillation and advanced liver fibrosis on treatment with vitamin K or non-vitamin K antagonist oral anticoagulants[J].Int J Cardiol,2018,264:58-63.
[14]Devereaux PJ,Duceppe E,Guyatt G,et al.Dabigatran in patients with myocardial injury after non-cardiac surgery(MANAGE):an international,randomised,placebo-controlled trial[J].Lancet,2018,391(10137):2325-2334.
[2]Fareed J,Thethi I,Hoppensteadt D.Old versus new oral anticoagulants:focus on pharmacology[J].Annu Rev Pharmacol Toxicol,2012,52:79-99.
[3]Ruff CT,Giugliano RP,Braunwald E,et al.Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation:a meta-analysis of randomised trials[J].Lancet,2014,383(9921):955-962.
[4]Larsen TB,Skjth F,Nielsen PB,et al.Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation:propensity weighted nationwide cohort study[J].BMJ,2016,353:i3189.
[5]Renda G,Ricci F,Giugliano RP,et al.Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and valvular heart disease[J].J Am Coll Cardiol,2017,69(11):1363-1371.
[6]Lip GYH,Collet JP,Caterina R,et al.Antithrombotic therapy in atrial fibrillation associated with valvular heart disease:a joint consensus document from the European Heart Rhythm Association(EHRA)and European Society of Cardiology Working Group on Thrombosis,endorsed by the ESC Working Group on Valvular Heart Disease,Cardiac Arrhythmia Society of Southern Africa(CAS-SA),Heart Rhythm Society(HRS),Asia Pacific Heart Rhythm Society(APHRS),South African Heart(SA Heart)Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología(SOLEACE)[J].Europace,2017,19(11):1757-1758.
[7]Pan KL,Singer DE,Ovbiagele B,et al.Effects of non-vitamin K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and valvular heart disease-a systematic review and meta-analysis[J].J Am Heart Assoc,2017,6(7).pii:e005835.
[8]Gibson CM,Mehran R,Bode C,et al.Prevention of bleeding in patients with atrial fibrillation undergoing PCI[J].N Engl J Med,2016,375(25):2423-2434.
[9]Cannon CP,Bhatt DL,Oldgren J,et al.Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation[J].N Engl J Med,2017,377(16):1513-1524.
[10]Del-Carpio Munoz F,Gharacholou SM,Munger TM,et al.Meta-analysis of renal function on the safety and efficacy of novel aral anticoagulants for atrial fibrillation[J].Am J Cardiol,2016,117(1):69-75.
[11]Qamar A,Bhatt DL.Stroke prevention in atrial fibrillation in patients with chronic kidney disease[J].Circulation,2016,133(15):1512-1515.
[12]Chokesuwattanaskul R,Thongprayoon C,Tanawuttiwat T,et al.Safety and efficacy of apixaban versus warfarin in patients with end stage renal disease:metaanalysis[J].Pacing Clin Electrophysiol,2018,41(6):627-634.
[13]Pastori D,Lip GYH,Farcomeni A,et al.Incidence of bleeding in patients with atrial fibrillation and advanced liver fibrosis on treatment with vitamin K or non-vitamin K antagonist oral anticoagulants[J].Int J Cardiol,2018,264:58-63.
[14]Devereaux PJ,Duceppe E,Guyatt G,et al.Dabigatran in patients with myocardial injury after non-cardiac surgery(MANAGE):an international,randomised,placebo-controlled trial[J].Lancet,2018,391(10137):2325-2334.