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新型口服抗凝药在房颤和ACS中将上位

2012-04-16 高晓方译 医学论坛网

口服抗凝药房颤ACS
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　　欧洲心脏病学会（ESC）血栓工作组的一篇综述表明，新型口服抗凝药在诸多房颤患者中可取代维生素K拮抗剂，并且在急性冠脉综合征后有应用价值。论文发表于《美国心脏病学会杂志》[J Am Coll Cardiol 2012, 59:1413]。 　　直到不久前，维生素K拮抗剂仍是唯一可用的口服抗凝药，但其存在的诸多限制促使人们引入新型口服抗凝药。新型

　　欧洲心脏病学会（ESC）血栓工作组的一篇综述表明，新型口服抗凝药在诸多房颤患者中可取代维生素K拮抗剂，并且在急性冠脉综合征后有应用价值。论文发表于《美国心脏病学会杂志》[J Am Coll Cardiol 2012, 59:1413]。

　　直到不久前，维生素K拮抗剂仍是唯一可用的口服抗凝药，但其存在的诸多限制促使人们引入新型口服抗凝药。新型口服抗凝药以单一的凝血酶（达比加群）或Xa因子（阿哌沙班、利伐沙班和依杜沙班）为靶点，并可在无需凝血检测的情况下以固定剂量用药。

　　此篇综述对上述新药在卒中预防和急性冠脉综合征后二级预防方面的临床试验结果进行了评价。作者指出，在房颤Ⅲ期试验中，与华法林相比，达比加群酯150 mg BID可降低卒中/全身栓塞发生率，并且在大出血方面无差异；达比加群酯110 mg BID具有相似的疗效并且可减少出血；阿哌沙班5 mg BID可减少卒中、全身栓塞、死亡以及大出血；利伐沙班20 mg QD在减少卒中和全身栓塞方面不劣于华法林，并且在大出血方面无差异。上述药物均可减少颅内出血。更大规模的Ⅲ期试验正在对依杜沙班进行评估。Ⅲ期试验对阿哌沙班和利伐沙班预防复发性缺血进行了评估，受试者为大部分接受双重抗血小板治疗的急性冠脉综合征患者，在疗效方面结果存在矛盾，但均增加大出血。

　　链接：

　　New Oral Anticoagulants in Atrial Fibrillation and Acute Coronary Syndromes

　　ESC Working Group on Thrombosis—Task Force on Anticoagulants in Heart Disease Position Paper



    

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1943152, encodeId=1c1019431526b, content=<a href='/topic/show?id=994f5820890' target=_blank style='color:#2F92EE;'>#新型口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58208, encryptionId=994f5820890, topicName=新型口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6fc262, createdName=zhangmingxiang, createdTime=Wed Feb 13 11:47:00 CST 2013, time=2013-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278993, encodeId=12de12e899371, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Wed Apr 18 11:47:00 CST 2012, time=2012-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377342, encodeId=c32a13e7342bb, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Apr 18 11:47:00 CST 2012, time=2012-04-18, status=1, ipAttribution=)]
    2013-02-13 zhangmingxiang

    #新型口服抗凝药#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1943152, encodeId=1c1019431526b, content=<a href='/topic/show?id=994f5820890' target=_blank style='color:#2F92EE;'>#新型口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58208, encryptionId=994f5820890, topicName=新型口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6fc262, createdName=zhangmingxiang, createdTime=Wed Feb 13 11:47:00 CST 2013, time=2013-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278993, encodeId=12de12e899371, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Wed Apr 18 11:47:00 CST 2012, time=2012-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377342, encodeId=c32a13e7342bb, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Apr 18 11:47:00 CST 2012, time=2012-04-18, status=1, ipAttribution=)]
    2012-04-18 yaanren

    #ACS#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1943152, encodeId=1c1019431526b, content=<a href='/topic/show?id=994f5820890' target=_blank style='color:#2F92EE;'>#新型口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58208, encryptionId=994f5820890, topicName=新型口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6fc262, createdName=zhangmingxiang, createdTime=Wed Feb 13 11:47:00 CST 2013, time=2013-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278993, encodeId=12de12e899371, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Wed Apr 18 11:47:00 CST 2012, time=2012-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377342, encodeId=c32a13e7342bb, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Apr 18 11:47:00 CST 2012, time=2012-04-18, status=1, ipAttribution=)]
    2012-04-18 hunizi005

    #口服抗凝药#

    0

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