新型直接口服抗凝药物与胃肠道出血的研究进展

New direct oral anticoagulants and associated gastrointestinal bleeding:research progress

2010年,一类新型直接口服抗凝药(DOAC)被批准用于非瓣膜性心房颤动患者预防血栓性脑卒中及治疗静脉血栓栓塞症(VTE)/肺栓塞(PE)。与传统口服抗凝药维生素K拮抗剂(VKA)相比,DOAC的抗凝效果确切,安全性更好、服用更方便,且更少引起颅内出血事件,但可能会增加胃肠道的出血风险。由于DOAC的半衰期短,大多数胃肠道出血无需特殊处理,但在出血危及生命或急诊手术时需给予逆转剂抵抗DOAC的抗凝作用。本文旨在对DOAC相关胃肠道出血的发生率、预防治疗及DOAC特异性逆转剂等作一综述。

A new type of direct oral anticoagulants（DOACs）was approved for the prevention of thrombotic stroke in patients with nonvalvular atrial fibrillation and for treatment of venous thrombosis（VTE）/pulmonary infarction（PE）in 2010.Compared with the traditional oral anticoagulant vitamin K antagonist（VKA）,DOACs have similar anticoagulant effect,better safety,easier administration and less intracranial hemorrhage,but it may increase the risk of gastrointestinal bleeding.As the half-life of DOACs is short,most gastrointestinal bleeding caused by DOACs does not require special treatment,but in rare situations,such as life-threatening bleeding or emergency surgery,DOACs reversal agent was needed to resist the anticoagulation of DOAC.In this review,we summarized the current status of DOACs,incidence of DOACs associated gastrointestinal bleeding,related prophylaxis and DOACs-specific reversal agents.