新型口服抗凝藥達比加群

1、新型口服抗凝藥達比加群酯,2015.8.13,參 考 文 獻,中華心血管病雜志編輯委員會血栓栓塞防治循證工作組. 達比加群酯用于非瓣膜病心房顫動患者卒中預(yù)防的臨床應(yīng)用建議[J]. 中華心血管病雜志, 2014, 42(3):188-192.Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillation[J]. Ne

2、w 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 Mookad

3、am. Novel Anticoagulants in Atrial Fibrillation: A Primer for the Primary Physician. J Am Board Fam Med. 2015 28:510-522.Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, Ph

4、D,Non–Vitamin 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

5、 of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers,Lancet, 2015 Jun 15.DOI:http://dx.doi.org/10.1016/s0140 - 6736(15)60732 - 2|,抗凝藥物作用靶點“瀑布反應(yīng)鏈條”,Mekaj YH, Mekaj AY, Duc

6、i 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 Man

7、agement. 2015;11:967-977.,抗凝藥物藥代動力學(xué),Martina Mookadam, Fadi E. Shamoun, Farouk Mookadam. Novel Anticoagulants in Atrial Fibrillation: A Primer for the Primary Physician. J Am Board Fam Med. 2015 28:510-522.,RE-LY試驗:

8、非劣效實驗,明確達比加群的療效不劣于華法林 中位隨訪2年,,,,,,,Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillation[J]. New England Journal of Medicine, 2009, 361(8):1139-1151.,主要終點事件,Houston D S, Zarychanski

9、 R. Dabigatran versus warfarin in patients with atrial fibrillation[J]. New England Journal of Medicine, 2009, 361(8):1139-1151.,,,,,出血風(fēng)險,Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fib

10、rillation[J]. New England Journal of Medicine, 2009, 361(8):1139-1151.,,,,,,不良反應(yīng),Houston D S, Zarychanski R. Dabigatran versus warfarin in patients with atrial fibrillation[J]. New England Journal of Medicine, 2009, 361(

11、8):1139-1151.,,,,,AHA亞洲人群薈萃分析,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonva

12、lvular 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,Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian P

13、atients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,AHA亞洲人群薈萃分析,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,Non–Vitamin K Antagonist Oral Anticoagulants fo

14、r Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,AHA亞洲人群薈萃分析,Kang-Ling Wang, MD, Gregory Y.H. Lip, MD, Shing-Jong Lin, MD, PhD and Chern-En Chiang, MD, PhD,Non–Vitamin K Ant

15、agonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation,Stroke,2015. July 30,AHA亞洲人群薈萃分析,達比加群的拮抗劑：idarucizumab,Glund S, Stangier J, Schmohl M, et al,Safety, tolerability,

16、and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers,Lancet, 2015 Jun 15.DOI:http://dx.doi.org/10.1016/s0140 - 6736(15)60732 - 2|,Glund S, Stangier J, Schmohl

17、 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,達比加群的拮抗劑：idarucizumab,Glund S, Stangier J, Schmohl M, et

18、 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:http://dx.doi.org/10.1016/s0140 - 6736(15)60732 - 2|,小

19、 結(jié),房顫預(yù)防卒中和全身性栓塞以及大出血發(fā)生率比較：110mg的達比加群在房顫預(yù)防卒中和全身性栓塞發(fā)生率相似，大出血發(fā)生率低。150mg的達比加群在房顫預(yù)防卒中和全身性栓塞優(yōu)于華法林，大出血發(fā)生率相似，但消化道出血明顯偏高。有消化道出血風(fēng)險的患者，應(yīng)給予110mg的達比加群。應(yīng)在餐時或餐后口服達比加群110mg的達比加群（≥75歲、CCr為30-50ml/min） CCr＜30ml/min禁用達比加群，改用華法林房

20、顫合并冠心病、心肌梗死、PCI術(shù)后的患者，應(yīng)優(yōu)先選擇華法林，不能監(jiān)測INR的患者，可選用達比加群與P-gp抑制劑及底物合用時需要注意達比加群的的出血風(fēng)險（維拉帕米、地爾硫卓、胺碘酮、地高辛等）,,中華心血管病雜志編輯委員會血栓栓塞防治循證工作組. 達比加群酯用于非瓣膜病心房顫動患者卒中預(yù)防的臨床應(yīng)用建議[J]. 中華心血管病雜志, 2014, 42(3):188-192.Moss JD, Cifu AS.Management of