首页> 外文期刊>Canadian family physician: Medecin de famille canadien >Approach to the new oral anticoagulants in family practice: Part 2: Addressing frequently asked questions [Approche à l'égard des nouveaux anticoagulants oraux en pratique familiale: 2e partie : Répondre aux questions souvent posées]
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Approach to the new oral anticoagulants in family practice: Part 2: Addressing frequently asked questions [Approche à l'égard des nouveaux anticoagulants oraux en pratique familiale: 2e partie : Répondre aux questions souvent posées]

机译:家庭实践中新型口服抗凝剂的使用方法:第2部分:解决常见问题[家庭实践中新型口服抗凝剂的方法:第2部分:回答常见问题]

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Objective To address common "what if" questions that arise relating to the long-term clinical follow-up and management of patients receiving the new oral anticoagulants (NOACs).Sources of information For this narrative review, we searched the PubMed database for recent (January 2008 to week 32 of 2013) clinical studies relating to NOAC use for stroke prevention in atrial fibrillation and for the treatment of acute venous thromboembolism. We used this evidence base to address prespecified questions relating to NOAC use in primary care settings.Main message Dabigatran and rivaroxaban should be taken with meals to decrease dyspepsia and increase absorption, respectively. There are no dietary restrictions with any of the NOACs, beyond moderating alcohol intake, and rivaroxaban and apixaban can be crushed if required. The use of acid suppressive therapies does not appear to affect the efficacy of the NOACs. As with warfarin, patients taking NOACs should avoid long-term use of nonsteroidal anti-i flammatory and antiplatelet drugs. For patients requiring surgery, generally NOACs should be stopped 2 to 5 days before the procedure, depending on bleeding risk, and the NOAC should usually be resumed at least 24 hours after surgery. Preoperative coagulation testing is generally unnecessary. In patients who develop bleeding, minor bleeding typically does not require laboratory testing or discontinuation of NOACs; with major bleeding, the focus should be on local measures to control the bleeding and supportive care, and coagulation testing should be performed. There are currently no antidotes to reverse NOACs. The NOACs should not be used in patients with valvular heart disease, prosthetic heart valves, cancer-associated deep vein thrombosis, or superficial thrombophlebitis.Conclusion Management of "what if" scenarios for patients taking NOACs have been proposed, but additional study is needed to address these issues, especially periprocedural management and bleeding.
机译:目的旨在解决与接受新型口服抗凝剂(NOAC)的患者的长期临床随访和管理有关的常见“假设”问题。信息源为了进行叙述性综述,我们在PubMed数据库中搜索了近期( 2008年1月至2013年第32周)与NOAC用于房颤预防中风和急性静脉血栓栓塞治疗的临床研究。我们使用该证据基础来解决与在初级保健机构中使用NOAC有关的预先指定的问题。主要信息达比加群和利伐沙班应随餐服用,以分别减少消化不良和增加吸收。除了适度饮酒外,任何NOAC都没有饮食限制,如果需要,可以粉碎利伐沙班和阿哌沙班。使用酸抑制疗法似乎不会影响NOAC的功效。与华法林一样,服用NOAC的患者应避免长期使用非甾体类抗i炎症和抗血小板药物。对于需要手术的患者,根据出血风险,通常应在手术前2至5天停止NOAC,通常应在手术后至少24小时恢复NOAC。通常不需要术前凝血测试。在发生出血的患者中,轻微出血通常不需要实验室测试或中止NOAC。对于严重出血,应将重点放在控制出血和支持治疗的局部措施上,并应进行凝血测试。当前没有解药可以逆转NOAC。患有瓣膜性心脏病,人工心脏瓣膜,癌症相关的深静脉血栓形成或浅表性血栓性静脉炎的患者不应使用NOAC。解决这些问题,尤其是围手术期处理和出血。

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