直接口服抗凝药物的实验室监测进展  

Advances in laboratory monitoring of direct oral anticoagulants

作　　者：吴雪莲[1] 屈晨雪[1] 戴菊华 李丽萍[1] 

机构地区：[1]北京大学第一医院检验科,100034

出　　处：《中华检验医学杂志》2017年第7期544-547,共4页Chinese Journal of Laboratory Medicine

摘　　要：直接口服抗凝药（DOACs）,包括直接凝血酶抑制剂及直接Xa因子抑制剂.因其药代动力学、药理作用研究较为清楚,且血药浓度不受食物影响,故理论上无需常规监测抗凝效果.然而近年临床实践发现,用药期间发生血栓形成、大出血、急诊手术,肝/肾功能不全等情况时需要监测DOACs抗凝效果.大量研究显示,常规凝血试验活化部分凝血活酶时间（APTT）或凝血酶时间（TT）可作为直接凝血酶抑制剂达比加群酯的实验室筛查指标,凝血酶原时间（PT）可作为直接Xa因子抑制剂利伐沙班的筛查指标.DOACs定量监测包括针对直接凝血酶抑制剂的稀释凝血酶时间（dTT） 、Hemoclot凝血酶抑制试验（HTI）、ecarin蛇毒凝固时间（ECT）或ecarin蛇毒发色试验（ECA）以及针对利伐沙班的抗FXa试验（利伐沙班定标）.实验室在开展这些实验时,应建立适用于自己实验室的监测范围. Direct oral anticoagulants,include direct thrombin inhibitor and direct factor Xa inhibitor.As the pharmacokinetics and pharmacodynamics of these drugs are known,their plasma concentration is not food-effective,and theoretically it is not necessary to monitor routinely.However, clinical practice in recent years has shown that anticoagulant effect of DOACs is required to evaluate in patients with thrombosis, major bleeding, emergency surgery, hepatic/renal dysfunction and other special situations.Recent studies have shown that routine coagulation assays such as activated partial thromboplastin time（APTT） and thrombin time（TT） can be used as laboratory screening tests for direct thrombin inhibitor dabigatran and prothrombin time（PT） can be used as laboratory screening test for direct factor Xa inhibitor rivaroxaban.DOAC′s quantitative measurements include dilute thrombin time（dTT）,hemoclot thrombin inhibitor （HTI）,ecarin clotting time （ECT） and ecarin chromogenic assay （ECA） for direct thrombin inhibitor and anti-FXa assay（rivaroxaban calibration） for rivaroxaban.Laboratories should establish their own monitoring range when performing these assays.

关 键 词：抗凝药 投药 口服 药物监测 血药浓度 实验室 

分 类 号：R446.1[医药卫生—诊断学]