新型口服抗凝药与华法林临床应用的比较.pdfVIP

药物与临床 Drugs and Clinic 新型口服抗凝药与华法林临床应用的比较 1 2 3* 2* 郭梦园 ，赵志刚 ，孙树森 ，李新刚 1.首都医科大学化学生物学与药学院临床药学系，北京 100069 ；2.首都医科大学附属北京天坛医院药剂科，北京 100050 ；3.美 国西新英格兰大学药学院，美国 马萨诸塞 01119 [摘要] 近年来，美国FDA批准了达比加群、利伐沙班和阿哌沙班三种新型口服抗凝剂(Novel Oral Anticoagulants, NOACs) ，并相继 在国内获准上市。NOACs在作用机制上有别于华法林，能直接抑制凝血因子而发挥抗凝作用，具有起效快、无需监测INR值和药 物食物相互作用少等优点。相关临床试验证明NOACs在临床使用时可以显著降低患者颅内出血风险，但其大剂量使用引起各种 出血的副作用仍然值得重视，对于肾功能不全的患者来说，服用NOACs需要进行剂量的调整。华法林和NOACs在临床相互转换 时应当特别注意对患者凝血功能的监测。本文对NOACs与华法林在临床上的应用进行了综述，以供临床药师参考。 [关键词] 新型口服抗凝剂；华法林；抗凝；出血 [中图分类号] R973+.2　　[文献标识码]　A　　[文章编号]　1672-2809(2015)04-0024-06 The Comparison between Novel Oral Anticoagulants and Warfarin in Clinical Application 1,2 2 3* 2* GUO Meng-yuan , ZHAO Zhi-gang , SUN Shu-sen , LI Xin-gang 1. Department of Clinical Pharmaceutical, School of Chemical Biology and Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China; 2. Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China;3. College of Pharmacy, Western New England University, Springfield, MA 01119, United States [Abstract] In recent years, the US Food and Drug Administration approved three novel oral anticoagulants(NOACs), including dabigatran, rivaroxaban and apixaban. These drugs have also been approved in China. Compared with warfarin, the NOACs have different mechanisms of action with direct inhibition of blood coagulation factors. The NOACs have practical advantages over warfarin, such as rapid onset of action, fixed-dose regimens without the need for routine monitoring of INR values, and a low potential for food and drug interactions. At the same time, the related clinical trials demonstrate that NOACs can significantly reduce the risk of intracranial bleeding in patients, but risks of all sorts of bleeding may still exist especially when they are used in large doses. For patients wi