华法林的临床应用0406.ppt

* There are many targets for novel anticoagulants in the coagulation pathway: Tissue factor pathway inhibitor (TFPI) bound to Factor Xa inactivates the tissue factor (TF)–Factor VIIa complex. preventing initiation of coagulation Activated protein C (APC) degrades Factors Va and VIIIa. and thrombomodulin (soluble; sTM) converts thrombin (Factor IIa) from a procoagulant to a potent activator of protein C Fondaparinux and idraparinux indirectly inhibit Factor Xa. requiring antithrombin (AT) as a cofactor Direct (AT-independent) inhibitors of Factor Xa include rivaroxaban (BAY?59-7939). LY517717. YM150 and DU-176b (all orally available). and DX-9065a (intravenous) Oral. direct thrombin inhibitors include ximelagatran (now withdrawn) and dabigatran Weitz JI Bates SM. New anticoagulants. J Thromb Haemost 2005;3:1843–1853 * * * * * * * * * * * * * Vascular disease (in CHA2DS2-VASc) is defined as MI, aortic plaque or PAD. References Camm et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369–429. * * * * * There are many targets for novel anticoagulants in the coagulation pathway: Tissue factor pathway inhibitor (TFPI) bound to Factor Xa inactivates the tissue factor (TF)–Factor VIIa complex. preventing initiation of coagulation Activated protein C (APC) degrades Factors Va and VIIIa. and thrombomodulin (soluble; sTM) converts thrombin (Factor IIa) from a procoagulant to a potent activator of protein C Fondaparinux and idraparinux indirectly inhibit Factor Xa. requiring antithrombin (AT) as a cofactor Direct (AT-independent) inhibitors of Factor Xa include rivaroxaban (BAY?59-7939). LY517717. YM150 and DU-176b (all orally available). and DX-9065a (intravenous) Oral. direct thrombin inhibitors include ximelagatran (now withdrawn) and dabigatran Weitz JI Bates SM. New anticoagulants. J Thromb Haemost 2005;3:1843–1853 * * *