非维生素K拮抗剂口服抗凝剂在机械心脏瓣膜置换术后治疗中的应用进展  

Progress of Non-Vitamin K Antagonist Oral Anticoagulants Applying in Mechanical Heart Valve Replacement

作　　者：李诗思 李松 张永 LI Shisi;LI Song;ZHANG Yong(Department of Cardiovascular Surgery,The Second Affiliated Hospital of Army Medical University,Chongqing,China 400037;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,Liaoning,China 110016)

机构地区：[1]中国人民解放军陆军军医大学第二附属医院心血管外科,重庆400037 [2]中国人民解放军北部战区总医院心血管外科,辽宁沈阳110016

出　　处：《中国药业》2020年第18期96-96,I0001,I0002,共3页China Pharmaceuticals

基　　金：中国人民解放军陆军军医大学苗圃人才培养计划[2019R054]。

摘　　要：目的为非维生素K拮抗剂口服抗凝剂(NOACs)在机械心脏瓣膜(MHV)置换术后治疗中的临床应用提供参考。方法统计已公开发表的比较直接凝血酶抑制剂及凝血因子Ⅹa抑制剂与华法林用于MHV置换术后患者抗凝效果的文献,分析其有效性及安全性。结果与结论NOACs在房颤、深静脉血栓、关节置换等的治疗中已逐渐替代华法林。但RE-ALIGN的Ⅱ期临床研究结果显示,NOACs用于MHV置换术后患者是绝对禁忌。不过,鉴于其在其他疾病治疗中体现出来的较华法林更好的安全性和类似的疗效,仅凭一个NOAC的单次临床试验并不能提供足够的证据来否定NOACs用于MHV置换术后抗凝的治疗策略。Objective To provide reference for the clinical application of non-vitamin K antagonist oral anticoagulants(NOACs)in mechanical heart valve(MHV)replacement.Methods The published literature comparing the anticoagulant effects of direct thrombin inhibitors and coagulation factorⅩa inhibitors with warfarin for patients after MHV replacement was statistically calculated to analyze their effectiveness and safety.Results and Conclusion NOACs have gradually replaced warfarin in the treatment of atrial fibrillation,deep vein thrombosis,and joint replacement,but the results of the PhaseⅡclinical study of RE-ALIGN showed that NOACs were absolutely contraindicated in patients after MHV replacement.However,in view of its better safety and similar efficacy than warfarin in the treatment of other diseases,a single clinical trial of NOAC alone cannot provide sufficient evidence to deny the use of NOACs after MHV replacement.

关 键 词：机械心脏瓣膜置换术后 口服 非维生素K拮抗剂抗凝剂 华法林 抗凝治疗 进展 

分 类 号：R973.2[医药卫生—药品]