背景:最近更新了关于静脉血栓栓塞症(VTE)治疗的第10版CHEST指南和专家小组报告,其中就抗凝剂的选择和不同临床情况下的治疗持续时间提出了建议。
方法:在本文中,我们关注使用直接口服抗凝剂(DOACS)的新闻,一组合成的低分子量药物,能够直接和特异性地抑制活化的因子X或同时抑制游离和纤维蛋白结合的凝血酶。
结果:指南的新内容是建议在没有发生VTE的癌症患者中使用DOACS而不是维生素K拮抗剂(VKA)。对于下肢和上肢血栓形成或肺栓塞,抗凝剂的选择和强度相同。对于癌症相关的血栓形成,仍然建议使用低分子量肝素,而不是使用VKA或DOACS,尽管缺乏这种选择的高质量证据。如果治疗超过三个月,建议使用相同的抗凝剂。经常使用DOAC时的再血栓形成需要转换为低分子量肝素至少一个月。
结论:最终,抗凝剂的选择将取决于患者的特定因素,例如合并症,合规,患者偏好,可用性和成本。我们从中高收入经济的角度来解决DOAC在VTE中使用的新闻。
BACKGROUND: The 10th edition of the CHEST
Guideline and Expert Panel Report for the treatment of venous thromboembolism (VTE) was recently updated with recommendations on both the choice of anticoagulants and the duration of treatment in diverse clinical scenarios.
METHODS: In this paper, we focus on news in the use of direct oral anticoagulants (DOACS), a group of synthetic low molecular weight drugs capable of directly and specifically inhibiting either activated factor X or both free and fibrin- bound thrombin.
RESULTS: New to the
guidelines is the recommendation of the use of DOACS over vitamin K-antagonists (VKA´s) in individuals without cancer who develop VTE. The choice and intensity of anticoagulants is the same for lower and upper extremity thrombosis or for pulmonary embolism. For cancer-related thrombosis low molecular weight heparin is still recommended over the use of VKA´s or DOACS, though high quality evidence for this choice is lacking. If therapy is given beyond three months, remaining on the same anticoagulant is suggested. Re-thrombosis while on regular use of DOACs requires switching to low molecular weight heparins at least for one month.
CONCLUSIONS: Ultimately the choice of anticoagulant will depend on patient-specific factors such as comorbidities, compliance, patient preferences, availability and costs. We address the news in DOAC use in VTE from the perspective of an upper-middle income economy.