PDF(Pubmed)
Abstract：
Factor Xa (FXa) inhibitors are widely used for stroke prevention in patients with nonvalvular atrial fibrillation, and for the treatment and prevention of deep venous thrombosis and pulmonary embolism. Compared with warfarin, individual FXa inhibitors are associated with a lower risk of major bleeding. Nevertheless, bleeding remains a feared complication of any anticoagulant therapy. Despite their demonstrated safety, implementation of FXa inhibitors in clinical practice may have been limited by the lack of a specific antidote. Recently, however, the United States Food and Drug Administration and the European Medicines Agency approved andexanet alfa for reversal of anticoagulation in patients treated with rivaroxaban or apixaban who have life-threatening or uncontrolled bleeding. This review will discuss andexanet alfa\'s mode of action, indication for use and efficacy, with a focus on its appropriate use in clinical practice. Unnecessary usage should be prevented as this may compromise patient safety. Assessment of potentially suitable patients by a multidisciplinary team, use according to the institutional protocol and central storage, all contribute to proper use of andexanet alfa. A practical tool to direct appropriate use of andexanet alfa is proposed.
摘要：
因子Xa（FXa）抑制剂广泛用于预防非瓣膜性心房颤动患者的中风，并用于治疗和预防深静脉血栓和肺栓塞。与华法林相比,单独的FXa抑制剂与较低的大出血风险相关.然而，出血仍然是任何抗凝治疗的令人担忧的并发症.尽管他们证明了安全，FXa抑制剂在临床实践中的应用可能受到缺乏特异性解毒剂的限制.最近,然而,美国食品和药物管理局和欧洲药品管理局批准andexanetalfa用于逆转利伐沙班或阿哌沙班治疗的危及生命或出血不受控制的患者的抗凝治疗.这篇综述将讨论andexanetalfa的作用模式，使用适应症和疗效，重点是在临床实践中的适当使用。应防止不必要的使用,因为这可能危及患者安全。由多学科小组评估潜在合适的患者，根据机构协议和中央存储使用，所有这些都有助于正确使用andexanetalfa。提出了一种指导适当使用andexanetalfa的实用工具。
