Abstract:
Oral anticoagulants are widely used to treat or prevent cardiovascular diseases in millions of patients worldwide. They are the drugs of choice for stroke prevention and systemic embolism in patients with non-valvular atrial fibrillation and prosthetic heart valves, as well as for treatment/prevention of venous thromboembolism. Oral anticoagulants include vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). The hemostasis laboratory plays a crucial role in the management of treated patients, spanning from dose adjustment based on laboratory testing that applies to VKAs to the measurement of drug concentrations in special situations that apply to DOACs. This article aims to overview how the hemostasis laboratory can help clinicians manage patients on oral anticoagulants. Special interest is devoted to the international normalized ratio, used to manage patients on VKAs and to the measurement of DOAC concentrations, for which the role of the laboratory is still not very well defined, and most interferences of DOACs with some of the most common hemostatic parameters are not widely appreciated.
摘要:
口服抗凝剂广泛用于治疗或预防全世界数百万患者的心血管疾病。它们是非瓣膜性心房颤动和人工心脏瓣膜患者预防中风和全身性栓塞的首选药物,以及静脉血栓栓塞的治疗/预防。口服抗凝剂包括维生素K拮抗剂(VKAs)和直接口服抗凝剂(DOAC)。止血实验室在治疗患者的管理中起着至关重要的作用,从基于适用于VKAs的实验室测试的剂量调整到适用于DOAC的特殊情况下的药物浓度测量。本文旨在概述止血实验室如何帮助临床医生管理口服抗凝剂的患者。特别感兴趣的是国际标准化比率,用于管理患者的VKAs和DOAC浓度的测量,实验室的作用还没有很好的定义,DOAC对一些最常见的止血参数的大多数干扰并未得到广泛重视。