新型口服抗凝药的临床应用拓展

Clinical application development of novel oral anticoagulants

目前临床使用时间最长、证据最强的抗凝药物是口服双香豆素类抗凝剂华法林,但其抗凝效果不可预测,需常规监测凝血功能指导临床用药剂量,否则容易出血,同时由于其治疗窗窄等缺点限制了其在临床上的广泛使用。近年出现的一些新型口服抗凝剂(Novel Oral Anticoagulants,NOACs),使用更加方便,不需要实验室监测,更重要的是,NOACs临床效果并不劣于华法林,甚至具有更好的疗效、安全性。最初,NOACs的临床应用主要体现在预防非瓣膜性心房纤颤患者发生脑卒中的效果,随着NOACs临床应用适应症的拓展,应用范围将更加广泛。

Warfarin is one of oral dicoumarol anticoagulants that has been used in clinical practice for long time with strong anticoagulant properties. However, its anticoagulant efficacy is unpredictable that requires frequent laboratory monitoring in order to guide the clinical practice. Otherwise, it easily causes bleeding. Meanwhile, its narrow therapeutic window also limits the widespread application. Recently, some novel oral anticoagulants （NOACs） are emerged. These NOACs are more convenient to use since they do not re- quire frequent monitoring. More important, they have similar clinical efficacy to warfarin, even better and safer. Initially, the clinical application of NOACs is mainly in the prevention of stroke in non-valvular atrial fibrillation, With expansion of clinicai application of NO- ACs,the scope of their application will be more extensive.