新型口服抗凝血劑於侵入性手術時之建議

Recommendations of the NOACs(Novel Oral Anti-Coagulants) in Invasive Surgical Proccdures

在過去數十年中維生素K拮抗劑warfarin是唯一的口服抗凝血劑。近來有兩項新型口服抗凝血齊已在台灣上市，包括直接凝血因子Xa抑制劑（direct factor Xa inhibitor） rivaroxaban與直接凝血酶原抑制劑（direct thrombin inhibitor） dabigatran。其藥物特質有別於傳統抗凝血劑wa rfarin，根據以往大型臨床研究顯示，這些新型口服抗凝血劑在非瓣膜性心房顫動患者，其預防血栓性中風之療效不亞於甚至優於傳統warfarin。此類藥品不僅有起始作用快之特性、穩定的血中藥物濃度、較少藥物與藥物或藥物與食物間之交互作用，而且連大出血之風險也較少，尤其是顱內出血等。

Vitamine K antagonist wafarin was the only oral anticoagulant for decades. Two novel oral anticoagluants (NOACs) were now available in Taiwan including direct factor Xa inhibitor (rivaroxaban) and direct thrombin inhibitor (dabigatran). The properties of the new oral anticoagulants are distinct from traditional anticoagulants such as warfarin. Based on past large clinical trials, these new NOACs have similar or even superior effect than traditional warfarin for thromboembolic stroke prevention in non-valvular atrial fibrillation (Af) patients. The NOACs not only have quick onset-offset property, stable serum drug level, less drug-drug or drug-food interactions, but also have less major bleeding risk especially intracranial bleeding. The NOACs are only contraindicated for limited conditions as valvular atrial fibrillation , severe liver or renal function impairment patients. However, some safety issues still concerned as drug effect is hardly evaluated by laboratory and antidotes are till not available in majority of hospitals worldwide. For patients scheduled for invasive procedure, carefully evaluate NAOCs dosing, timing of temporary stopping, or switching to other anticoagulant peri-procedure were all important issues needed understanding to achieved optimal cost-effectiveness.