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Application of new oral anticoagulants in elderly patients with venous thromboembolism

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Author:: No author available

Journal Title:: 国际呼吸杂志

Issue:: 22

DOI:: 10.3760/cma.j.issn.1673-436X.2016.22.019

Key Word:: 抗凝药;血栓栓塞;老年;凝血酶;Ⅹa因子;Anticoagulants;Thromboembolism;Elderly;Thrombin;Factor Ⅹa

Abstract： The incidence of venous thromboembolism (VTE) is increasing with age.The risk of bleeding increased in elderly patients with VTE who received anticoagulant therapy.The emergence of new oral anticoagulants(NOACs)provides a new choice for the treatment of VTE.NOACs include direct thrombin inhibitor and factor Ⅹa inhibitors.The direct thrombin inhibitor,dabigatran etexilate,and the factor Ⅹa inhibitors,rivaroxaban,apixaban and edoxaban have all been approved for the treatment of VTE.At present,the research results have showed that,for VTE patients over 75 years old,the efficacy of NOACs is consistent with or even better than conventional anticoagulant therapy,and the risk of major or clinically relevant bleeding is not significantly increased.VTE patients over 85 years old receiving dabigatran have greater risk of bleeding events than younger patients.The efficacy and safety of extended use of rivaroxaban and apixaban for the long-term treatment of elderly patients with VTE have been also confirmed.However,the results of these studies were derived from the subgroup analysis of randomized controlled trials,and further large randomized controlled trials are needed to fully confirm the safety of NOACs in the elderly patients with VTE.In addition,better solutions to other issues are also needed,such as lacking of effective antidote and laboratory monitoring means.

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