Would you use novel oral anticoagulants (NOACs) for thromboprophylaxis in patients with an underlying hypercoagulable state? A literature review through a case report.

您是否会使用新型口服抗凝剂 （ NOAC ） 预防潜在高凝状态患者的血栓形成 ？ 通过一例病例报告进行文献综述。

• 发表时间: Oct 2020 30
• 来源期刊: BMJ Case Rep
• DOI: 10.1136/bcr-2020-237238
• PMID: 33127703
• 文章类型: Case Reports
• 作者列表: Kakadia B,Suero-Abreu GA,Daci R,Then RK

关键词: haematology (incl blood transfusion); rheumatology; stroke; warfarin therapy

Mesh: Administration, Oral; Anticoagulants / administration & dosage; Antiphospholipid Syndrome / blood complications drug therapy; Blood Coagulation / drug effects; Computed Tomography Angiography; Echocardiography; Female; Humans; Middle Aged; Secondary Prevention / methods; Venous Thromboembolism / blood etiology prevention & control

Abstract

Antiphospholipid syndrome (APLS) is an autoimmune condition that predisposes to venous and arterial thrombosis. Warfarin is the agent of choice for anticoagulation. However, a need for routine international normalised ratio (INR) checks and multiple drug interactions are some of the difficulties with warfarin. Currently, there is mixed evidence for and against the use of novel oral anticoagulants (NOACs) for thromboprophylaxis. We present a case report of a patient with APLS on a NOAC for secondary thromboprophylaxis who developed a stroke and discuss current evidence regarding the use of NOACs in patients with APLS. The patient was switched to warfarin for secondary thromboprophylaxis with an INR goal of 2-3. Literature review revealed mixed case reports for and against NOACs for secondary prevention of thrombotic events in patients with APLS. There needs to be further randomised controlled trials to evaluate the efficacy of NOACs for thromboprophylaxis in patients with APLS.

摘要

抗磷脂综合征（APLS）是一种易于发生静脉和动脉血栓形成的自身免疫性疾病。华法林是抗凝血剂的选择。然而,需要进行常规的国际标准化比率(INR)检查和多种药物相互作用是华法林的一些困难.目前,支持和反对使用新型口服抗凝剂(NOAC)预防血栓形成的证据不一.我们提供了一例APLS患者在NOAC中进行二级血栓预防的病例报告，该患者发展为中风，并讨论了有关在APLS患者中使用NOAC的最新证据。患者改用华法林进行二级血栓预防，INR目标为2-3。文献综述显示，在APLS患者中，支持和反对NOAC二级预防血栓事件的混合病例报告。需要进一步的随机对照试验来评估NOAC对APLS患者血栓预防的疗效。