直接口服抗凝药在极端体重患者中应用的研究进展

Research Progress in the Application of Direct Oral Anticoagulants in Patients with Extreme Body Weight

直接口服抗凝药(DOACs)已被批准广泛用于非瓣膜房颤(NVAF)和静脉血栓栓塞(VTE)的预防和治疗。极端体重患者(BMI<18.5 kg·m^(-2)或≥30 kg·m^(-2))由于分布容积、半衰期和清除率等药代动力学发生改变,使DOACs的暴露量和清除率异于常人,从而影响其疗效和安全性。极端体重患者应用DOACs的研究有限且研究结果多有矛盾,目前对于该类患者的抗凝预防和治疗,指南仍推荐华法林而非DOACs。本文对极端体重患者应用DOACs的抗栓疗效和安全性作一综述。

Direct oral anticoagulants (DOACs) have been widely approved for prevention and treatmen of non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE).Patients with extreme body weight (BMI<18.5 kg·m^(-2)or≥30 kg·m^(-2)) have different exposure and clearance rate of DOACs than ordinary people due to changed distribution volume,half-life and clearance rate,thus affecting the efficacy and safety of DOACs.Studies on the use of DOACs in patients with extreme weight are limited and the results are often contradictory,so warfarin is still recommended rather than DOACs for anticoagulant prevention and treatment in these patients.This article aims to review the antithrombotic efficacy and safety of DOACs in patients with extreme body weight.