Over the last decade, the advent of direct oral anticoagulants (DOACs) has rapidly changed the landscape of anticoagulation. In the early 2010s, DOACs became widely available for stroke prevention in atrial fibrillation and the treatment of venous thromboembolism. About 10 years later, approximately two-thirds of patients requiring oral anticoagulant treatment were receiving a DOAC. The results of several post-marketing studies consistently confirmed the findings of phase 3 clinical trials, and research has focused on new areas of development, with heterogeneous results. A role for DOACs has emerged for patients with peripheral artery disease and other challenging conditions, such as cancer-associated thrombosis, unusual-site venous thromboembolism, and end-stage renal disease. Conversely, clinical trials showed that DOACs were not efficacious in patients with valvular atrial fibrillation, mechanical heart valves, embolic strokes of undetermined source, or antiphospholipid syndrome. In this Review, we discuss the impact of DOACs in clinical practice over the last decade, new areas under development, and practical issues in the management of these drugs.

中文翻译：

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抗凝治疗格局的变化：关注直接口服抗凝剂


在过去十年中，直接口服抗凝剂 （DOAC） 的出现迅速改变了抗凝治疗的格局。在 2010 年代初期，DOAC 广泛用于心房颤动的中风预防和静脉血栓栓塞的治疗。大约 10 年后，大约 2/3 需要口服抗凝治疗的患者接受了 DOAC。几项上市后研究的结果一致证实了 3 期临床试验的结果，研究集中在新的开发领域，结果各不相同。DOAC 在患有外周动脉疾病和其他具有挑战性的疾病（例如癌症相关血栓形成、不常见位点静脉血栓栓塞和终末期肾病）患者中的作用已经显现。相反，临床试验表明，DOAC 对瓣膜性心房颤动、机械心脏瓣膜、来源不明的栓塞性卒中或抗磷脂综合征患者无效。在本综述中，我们讨论了 DOAC 在过去十年中对临床实践的影响、正在开发的新领域以及这些药物管理中的实际问题。