抗凝药除利伐沙班外还有哪些？

In addition to the new oral anticoagulants currently commonly used, they also include apixaban, low molecular weight heparin, warfarin, etc. Patients can choose drugs under the guidance of a doctor.

Apixaban is an oral, selective inhibitor of activated factor Xa, used to prevent venous thrombosis (VTE) in adult patients undergoing elective hip or knee replacement, and this indication has also been approved in China.

Apixaban's Therapeutic Effectiveness Index in clinical study results shows that the best therapeutic effect is achieved at a dose of 2.5 mg taken twice daily.

Clinical data show that when oral apixaban is taken at the same dose as traditional anticoagulants, such as low molecular weight heparin or warfarin, apixaban has the advantages of lower bleeding incidence, good safety, and no need for monitoring.

Apixaban is mainly metabolized by CYP450 enzymes and P-glycoprotein in the liver, and is excreted from the gastrointestinal tract and kidneys. The excretion by the kidneys accounts for 27% of the total clearance rate, making it more suitable for patients with renal insufficiency.

low molecular weight heparin

As an anticoagulant, low molecular weight heparin has been used clinically for a long time. It has anti-thrombotic, anti-platelet aggregation, anti-inflammatory, and lipid-lowering effects. It has achieved good clinical effects in the treatment of various perinatal diseases such as habitual abortion, fetal growth restriction, oligohydramnios or abnormal umbilical blood flow values during pregnancy, preeclampsia, and intrahepatic cholestasis of pregnancy.

Low molecular weight heparin can act on coagulation factor Xa, prevent IL platelet aggregation and IL plug formation, reduce blood viscosity, and promote the conversion of plasminogen to plasmin. The pentopolysaccharide sequence of low molecular weight heparin can bind antithrombin with high mercury binding force and enhance the anticoagulant effect.

Low molecular weight heparin is a type of heparin depolymer and has roughly the same pharmacological effects as heparin. However, low molecular weight heparin has a stronger anti-thrombotic effect and has good efficacy in the treatment and prevention of thromboembolic diseases.

warfarin

Warfarin is a coumarin anticoagulant. It is widely used in the anticoagulant treatment of atrial fibrillation, deep vein thrombosis, pulmonary embolism, artificial valve transplantation, etc. due to its significant efficacy, long duration of action, and low price. Warfarin exerts its anticoagulant effect by inhibiting the synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X.

Warfarin has important applications in inhibiting thrombosis caused by venous thrombosis, pulmonary embolism, atrial fibrillation, and cardiac surgery. Patients with cardiovascular and cerebrovascular diseases taking warfarin can reduce the chance of death from thromboembolism.

In patients with atrial fibrillation who are at high risk of thromboembolism, anticoagulation with warfarin or new oral anticoagulants can significantly reduce thromboembolic events and improve patient prognosis.

Warfarin is a slower anticoagulant than heparin, but it does not require injection and can be administered orally. It has a longer half-life and a once-a-day dose can meet treatment needs. Warfarin can interact with a variety of Western medicines, and many Chinese herbal medicines and foods can also interact with it. Therefore, patients should follow the doctor's advice when taking other medicines.

In addition to the above drugs, anticoagulants also include edoxaban, edoxaban, and dabigatran. If patients experience side effects or develop tolerance after using rivaroxaban, the drug treatment plan can be adjusted in time and treated with other drugs such as low molecular weight heparin and warfarin.

References

1. [1] Xie Ping, Deng Jianjun, Hou Tingting. Progress in Anticoagulant Treatment of Atrial Fibrillation[C]//Chinese Journal of Cardiac Pacing and Cardiac Electrophysiology, Shenzhen Medical Doctors Association Cardiovascular Physicians Branch, Shenzhen Sun Yixian Cardiovascular Hospital, Shenzhen Continuing Medical Education Center. National Special Conference on New Progress in Arrhythmia Diagnosis and Treatment and Electrocardiography Technology (2015 ) and a compilation of materials from the special ablation treatment and surgical demonstration of difficult arrhythmias (National Seminar on Standardized Diagnosis and Treatment of Arrhythmias). [Unknown publisher], 2015: 52-54. DOI: 10.26914/c.cnkihy.2015.002286.

2[1] Ma Ji. Comprehensive study on the efficacy of total ginseng saponins on warfarin in rats [D]. Fuzhou University, 2016.

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