非维生素K拮抗剂口服抗凝药实验室监测及特殊人群使用  

Laboratory Monitoring of Non-Vitamin K Antagonist Oral Anticoagulants and Their Use in Special Populations

作　　者：应华波 黄晓[1] YING Hua-bo;HUANG Xiao(Department of Cardiology,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院心血管内科,江西南昌330006

出　　处：《中山大学学报（医学科学版）》2023年第5期728-734,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81960074);江西省重点研发项目(20203BBGL73173);江西省卫生健康委员会(202130440)。

摘　　要：在过去的数十年中,肝素和华法林是用于治疗和预防静脉血栓栓塞的主要抗凝药物。然而,随着非维生素K拮抗剂口服抗凝药(NOACs)的出现,国内外均有研究表明NOACs在预防和治疗静脉血栓栓塞以及非瓣膜心房颤动方面具有相似或更好的疗效和安全性。NOACs在固定剂量使用时不需要常规凝血监测,但在特殊人群或特定场景(急诊手术等)中,相对超剂量或剂量不足的药物使用及异常的药物代谢能力可能会降低药物疗效及安全性,监测和评估NOACs的抗凝血作用更有助于患者的预后。本文将从NOACs的常用实验室监测方法及特殊人群使用等两个方面做简要综述,旨在说明适合不同NOACs药物的监测方法及NOACs在相对特殊人群里的适用性,希望可以为临床规范监测及使用NOACs提供借鉴。In the past few decades,heparin and warfarin have been the main anticoagulants used to treat and prevent venous thromboembolism.Recent studies at home and abroad have shown that non-vitamin K antagonist oral anticoagu⁃lants(NOACs)have similar or better efficacy and safety in the prevention and treatment of venous thromboembolism and non-valvular atrial fibrillation.NOACs do not require routine coagulation monitoring when used at a fixed dose.However,in special populations or specific scenarios such as emergency surgery,etc.,an overdose or underdose and abnormal me⁃tabolism of NOACs may reduce the drug efficacy and safety,so monitoring and evaluating the anticoagulant effect of NO⁃ACs is more conducive to the prognosis of patients.This paper briefly reviewed the common laboratory monitoring methods of NOACs and their use in special populations,aiming to explain different monitoring methods for different NOACs and the applicability of NOACs in special populations,and hoping to provide reference for clinical standard monitoring and use of NOACS.

关 键 词：非维生素K拮抗剂口服抗凝药 实验室监测 血栓栓塞 临床应用 

分 类 号：R54[医药卫生—心血管疾病]