PDF(Pubmed)
Abstract：
It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.
摘要：
众所周知，直接口服抗凝剂（DOAC）是房颤（AF）和静脉血栓栓塞（VTE）抗凝策略的基石，应优于维生素K拮抗剂（VKAs），因为它们在降低血栓栓塞风险方面优于或不低于VKAs，并且与颅内出血（IH）的风险较低相关。此外,许多因素,如较少的药代动力学相互作用和较少的监测需要，有助于这种治疗策略。虽然DOAC代表更合适的选择，临床实践中应考虑的几个问题，包括药物-药物相互作用(DDI)，改用其他抗血栓治疗,程序前和程序后时期，以及慢性肾和肝衰竭患者以及癌症患者的使用。此外，对DOAC的依从性似乎仍然欠佳。这篇叙述性综述旨在为DOAC处方提供实用指南，并解决具有挑战性的场景。
