CAJ | 학술논문

新型抗凝药物主要包括直接凝血酶抑制剂和Xa因子抑制剂.其中,直接凝血酶抑制剂达比加群酯口服制剂、直接Xa因子抑制剂利伐沙班和阿哌沙班口服制剂已在我国上市;另外一种直接Xa因子抑制剂贝曲沙班口服制剂也正在进行Ⅲ期临床研究;而直接Xa因子抑制剂爱多沙班口服制剂已在日本上市.达比加群酯致颅内出血发生风险低于华法林,但该药可能增加急性冠状动脉综合征患者严重出血和具有临床意义轻度出血的发生率,以及心肌梗死或急性冠状动脉综合征的发生风险.利伐沙班在预防非瓣膜性心房颤动所致脑卒中和栓塞方面优于华法林,预防骨科术后血栓效果优于依诺肝素,大出血事件发生风险与两药相似,而颅内出血发生风险低于华法林.阿哌沙班在降低心房颤动患者脑卒中或全身性栓塞发生率及病死率方面优于华法林,颅内出血发生率低于华法林,大出血发生率与华法林相似或降低;阿哌沙班的安全性与用药剂量相关.爱多沙班的主要不良反应为出血,用于心房颤动患者的有效性及安全性均优于华法林.贝曲沙班用于全膝关节置换术后预防血栓效果与依诺肝素相似,出血发生率低于依诺肝素.
신형항응약물주요포괄직접응혈매억제제화Xa인자억제제.기중,직접응혈매억제제체비가군지구복제제、직접Xa인자억제제리벌사반화아고사반구복제제이재아국상시;령외일충직접Xa인자억제제패곡사반구복제제야정재진행Ⅲ기림상연구;이직접Xa인자억제제애다사반구복제제이재일본상시.체비가군지치로내출혈발생풍험저우화법림,단해약가능증가급성관상동맥종합정환자엄중출혈화구유림상의의경도출혈적발생솔,이급심기경사혹급성관상동맥종합정적발생풍험.리벌사반재예방비판막성심방전동소치뇌졸중화전새방면우우화법림,예방골과술후혈전효과우우의낙간소,대출혈사건발생풍험여량약상사,이로내출혈발생풍험저우화법림.아고사반재강저심방전동환자뇌졸중혹전신성전새발생솔급병사솔방면우우화법림,로내출혈발생솔저우화법림,대출혈발생솔여화법림상사혹강저;아고사반적안전성여용약제량상관.애다사반적주요불량반응위출혈,용우심방전동환자적유효성급안전성균우우화법림.패곡사반용우전슬관절치환술후예방혈전효과여의낙간소상사,출혈발생솔저우의낙간소.
New oral anticoagulants include direct thrombin inhibitor and factor Xa inhibitors.The direct thrombin inhibitor,dabigatran etexilate,and the factor Xa inhibitor,rivaroxaban and apixaban,have been approved in China; another oral agent,factor Xa inhibitor,betrixaban is being evaluated in a phase Ⅲ clinical trial ; meanwhile the direct factor Xa inhibitor,edoxaban has also been approved in Japan.Compared with warfarin,dabigatran etexilate was superior in reducing the risk of intracerebral hemorrage,but it may be associated with increase of major or clinically significant minor bleeding in patients with acute coronary syndromes and risk of acute myocardial infarction or acute coronary events.Rivamxaban has been found to be superior to warfarin for stroke prevention in nonvalvular atrial fibrillation with significant reduction in the risk of intracerebral hemorrage,superior to enoxaparin in prophylaxis of venous thromboembolism in orthopedic surgery with similar major bleeding risk.Compared with warfarin,apixaban was superior in reducing the risk of stroke,systemic embolism or death and was associated with less intracerebral hemorrage and a similar or lower rate of major bleeding.The safety of apixaban was associated with its dose.Efficacy and safety of edoxaban were superior to warfarin in atrial fibrillation with the adverse drug reactions of bleeding.Betrixaban was as effective as enoxaparin in preventing venous thromboembolism in knee replacement patients,but had a lower risk of bleeding.