新的口服抗凝药物预防和治疗癌症患者的静脉血栓栓塞。

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Gerotziafas GT,马希,Elalamy我

新的口服抗凝药物预防和治疗癌症患者的静脉血栓栓塞。

中国风险等。2014年6月13日;10:423-36。doi: 10.2147 / TCRM.S49063。eCollection 2014。

PubMed ID

24966680 (在PubMed

]

文摘

癌症患者有6-7-fold更高风险的静脉血栓栓塞(VTE)而非癌症患者。有效和安全的抗凝治疗静脉血栓栓塞的预防和治疗是癌症患者管理的基石,旨在降低发病率和死亡率,提高生活质量。依诺肝素、低分子量肝素,fondaparinux和维生素K拮抗剂(VKAs)用于癌症患者的静脉血栓栓塞的预防和治疗。肝素和fondaparinux皮下接种。VKAs口服有效,但他们有一个狭窄的治疗窗,许多食品和药物相互作用,治疗需要常规实验室监测和剂量调整。这些限制等有重要的负面影响病人的生活质量,减少坚持治疗。新的口服抗凝剂(NOAC)代理特定抑制剂激活因子Xa (——) (rivaroxaban和apixaban)或凝血酶(dabigatran)。预计NOACs将改善抗血栓形成的治疗。癌症患者是一个特殊的团体,可以用NOACs从治疗中获益。然而,NOACs存在一些显著的交互与药物经常用于癌症患者,这可能会影响他们的药物动力学,损害他们的有效性和安全性。 In the present review, we analyzed the available data from the subgroups of patients with active cancer who were included in Phase III clinical trials that assessed the efficacy and safety of NOACs in the prevention and treatment of VTE. The data from the Phase III trials in prophylaxis of VTE by rivaroxaban or apixaban highlight that these two agents, although belonging to the same pharmacological group (direct inhibitors of factor Xa), have substantially different profiles of efficacy and safety, especially in hospitalized acutely ill medical patients with active cancer. A limited number of patients with VTE and active cancer were included in the Phase III trials (EINSTEIN, AMPLIFY, and RE-COVER) which evaluated the efficacy and safety of NOACs in the acute phase and secondary prevention of VTE. Although, from a conceptual point of view, NOACs could be an attractive alternative for the treatment of VTE in cancer patients, the available data do not support this option. In addition, due to the elimination of the NOACs by the liver and renal pathway as well as because of their pharmacological interactions with drugs which are frequently used in cancer patients, an eventual use of these drugs in cancer patients should be extremely cautious and be restricted only to patients presenting with contraindications for low molecular weight heparins, fondaparinux, or VKAs. The analysis of the available data presented in this review reinforces the request for the design of new Phase III clinical trials for the assessment of the efficacy and safety of NOACs in specific populations of patients with cancer.

DrugBank数据引用了这篇文章

药物酶

药物	酶	类	生物	药理作用	行动
Dapoxetine	细胞色素P450 3 a4	蛋白质	人类	没有	底物 抑制剂	细节
Indalpine	细胞色素P450 3 a4	蛋白质	人类	没有	底物 抑制剂	细节
帕罗西汀	细胞色素P450 3 a4	蛋白质	人类	没有	底物 抑制剂	细节
舍曲林	细胞色素P450 3 a4	蛋白质	人类	未知的	底物 抑制剂	细节
Zimelidine	细胞色素P450 3 a4	蛋白质	人类	没有	抑制剂	细节