新型口服抗凝药达比加群

新型口服抗凝药达比加群酯,2015.8.13,参 考 文 献,中华心血管病杂志编辑委员会血栓栓塞防治循证工作组. 达比加群酯用于非瓣膜病心房颤动患者卒中预防的临床应用建议J. 中华心血管病杂志, 2014, 42(3):188-192.Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillationJ. New England Journal of Medicine, 2009, 361(8):1139-1151.Moss JD, Cifu AS.Management of Anticoagulation in Patients With Atrial Fibrillation.JAMA. 2015 Jul 21;314(3):291-2. Martina Mookadam, Fadi E. Shamoun, Farouk Mookadam. Novel Anticoagulants in Atrial Fibrillation: A Primer for the Primary Physician. J Am Board Fam Med. 201528:510-522.Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,NonVitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,StrokeAHA,2015. July 30Glund S, Stangier J, Schmohl M, et al,Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers,Lancet, 2015 Jun 15.DOI:/10.1016/s0140 - 6736(15)60732 - 2|,抗凝药物作用靶点“瀑布反应链条”,Mekaj YH, Mekaj AY, Duci SB, Miftari EI. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Therapeutics and Clinical Risk Management. 2015;11:967-977.,抗凝药物药代动力学,Martina Mookadam, Fadi E. Shamoun, Farouk Mookadam. Novel Anticoagulants in Atrial Fibrillation: A Primer for the Primary Physician. J Am Board Fam Med. 201528:510-522.,RE-LY试验: 非劣效实验,明确达比加群的疗效不劣于华法林 中位随访2年,Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillationJ. New England Journal of Medicine, 2009, 361(8):1139-1151.,主要终点事件,Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillationJ. New England Journal of Medicine, 2009, 361(8):1139-1151.,出血风险,Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillationJ. New England Journal of Medicine, 2009, 361(8):1139-1151.,不良反应,Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillationJ. New England Journal of Medicine, 2009, 361(8):1139-1151.,AHA亚洲人群荟萃分析,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,NonVitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,NonVitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,AHA亚洲人群荟萃分析,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,NonVitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,AHA亚洲人群荟萃分析,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,NonVitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,AHA亚洲人群荟萃分析,达比加群的拮抗剂：idarucizumab,Glund S, Stangier J, Schmohl M, et al,Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers,Lancet, 2015 Jun 15.DOI:/10.1016/s0140 - 6736(15)60732 - 2|,Glund S, Stangier J, Schmohl M, et al,Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers,Lancet,2015.7.15,达比加群的拮抗剂：idarucizumab,Glund S, Stangier J, Schmohl M, et al,Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers,Lancet, 2015 Jun 15.DOI:/10.1016/s0140 - 6736(15)60732 - 2|,小 结,房颤预防卒中和全身性栓塞以及大出血发生率比较：110mg的达比加群在房颤预防卒中和全身性栓塞发生率相似，大出血发生率低。150mg的达比加群在房颤预防卒中和全身性栓塞优于华法林，大出血发生率相似，但消化道出血明显偏高。有消化道出血风险的患者，应给予110mg的达比加群。应在餐时或餐后口服达比加群110mg的达比加群（75岁、CCr为30-50ml/min） CCr30ml/min禁用达比加群，改用华法林房颤合并冠心病、心肌梗死、PCI术后的患者，应优先选择华法林，不能监测INR的患者，可选用达比加群与P-gp抑制剂及底物合用时需要注意达比加群的的出血风险（维拉帕米、地尔硫卓、胺