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題 名 | 新抗凝血劑與傳統製劑之比較=New Anticoagulants versus Traditional Agents |
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作 者 | 張淑玲; 陳一伶; | 書刊名 | 藥學雜誌 |
卷 期 | 30:2=119 2014.06[民103.06] |
頁 次 | 頁27-34 |
分類號 | 418.2321 |
關鍵詞 | 抗凝血劑; 凝血因子; 維生素K拮抗劑; 低分子量肝素; Anti- factor Xa; Oral vitamin K antagonist; Warfarin; Low molecular weight heparin; |
語 文 | 中文(Chinese) |
中文摘要 | 維生素K拮抗劑難以掌控,此與其頻繁發生的不良事件息息相關。雖然 warfarin 已被證實可有效降低中風風險,但需要熟練的劑量控制技巧以及良好醫病溝通,才能 達到最佳的抗凝血效果。維生素K拮抗劑的作用機轉,主要作用在維生素K合成路徑 中的特定酶,會導致數個凝血因子 (如:II、VII、IX和X等因子) 的凝血機能減低,進 而達到抗凝血效果。而新抗凝血劑則直接用在某特定凝血因子,以取得抗凝血效果。 這些速效、作用期短不需要監測藥物血中濃度的新製劑,並非沒有使用限制或潛在不 良反應。雖然可預測劑量反應,因而不需常規監測,也因較少發生嚴重食物或藥物的 交互作用,因此簡化了管控。然而,對個別藥物來說,新製劑的代謝與排除途徑不盡 相同,彼此的腎廓清率上也有差異。新抗凝血劑中,口服直接凝血酶抑制劑及第 Xa 凝血因子抑制劑,這兩類藥物是其中發展得最好的。新口服抗凝劑與維生素K拮抗劑 有著不同的作用機轉,或許得以將之取代。 |
英文摘要 | The vitamin K antagonists (VKAs) are difficult to manage and associated with frequent adverse events. The VKA, warfarin, has been shown to reduce the risk of stroke. But it requires skillful dose management and patient communication to achieve the best outcomes. VKAs target an enzyme in the vitamin K pathway that leads to the reduction of the functional levels of factors II, VII, IX, and X, many of the new agents rely on targeting a particular coagulation factor and directly inhibiting it. These short-acting, short-duration, unmonitored drugs are not without limitations and potential adverse effects. They have predictable dose responses, thus eliminating the need for routine monitoring and fewer important food or drug interactions, thus simplifying management. However, they do have different routes of metabolism and elimination, with renal clearance playing a variable role with each drug. The oral direct thrombin and Xa inhibitors are furthest along in development. New oral anticoagulants with different mechanisms of action may replace the VKAs. |
本系統中英文摘要資訊取自各篇刊載內容。