Direct Oral Anticoagulants in Primary and Secondary Prevention of Thrombotic Events: 2026 ACC Scientific Statement: A Report of the American College of Cardiology.

Over the past decade, DOACs have become the preferred oral anticoagulants for most patients with atrial fibrillation and venous thromboembolism; yet, important gaps remain in their optimal implementation across diverse clinical scenarios.

在过去的十年中，DOACs已成为大多数房颤和静脉血栓栓塞患者首选的口服抗凝药；然而，在各种临床场景中实现其最佳应用仍存在重要的差距。

Despite strong evidence supporting their efficacy and safety, DOACs continue to be underutilized and sometimes inappropriately dosed, particularly among patients at elevated thrombotic risk and in populations historically underrepresented in randomized trials.

尽管有强有力的证据支持其疗效和安全性，DOACs（直接口服抗凝药物）的使用仍然不足，有时剂量不当，特别是在血栓风险较高的患者中，以及在历史上在随机试验中代表性不足的人群中。

This American College of Cardiology Scientific Statement provides a comprehensive, evidence-based overview of established and emerging indications for DOAC therapy in primary and secondary prevention of thrombotic events.

这份美国心脏病学会的科学声明提供了一个全面的、基于证据的概述，涵盖了DOAC治疗在预防血栓事件中的已确立和新兴的适应症。

Key domains include anticoagulation in atrial fibrillation, acute and extended treatment of venous thromboembolism, management in special populations (including patients with chronic kidney disease, liver dysfunction, cancer, obesity, frailty, prior bleeding, and valvular heart disease), periprocedural anticoagulation, and antithrombotic strategies following stroke, left atrial appendage closure, and catheter ablation.

关键领域包括房颤中的抗凝治疗、静脉血栓栓塞的急性及延长治疗、特殊人群（包括慢性肾病、肝功能障碍、癌症、肥胖、虚弱、既往出血和瓣膜心脏病患者）的管理、围手术期抗凝治疗以及中风后、左心耳封堵术和导管消融术后的抗血栓策略。

The document also addresses practical considerations such as drug selection, dosing strategies, duration of therapy, bleeding risk assessment, management of anticoagulant-related bleeding, drug-drug interactions, adherence, and cost-related barriers to care.

该文件还涉及实际考虑因素，如药物选择、剂量策略、治疗持续时间、出血风险评估、抗凝药物相关出血的管理、药物-药物相互作用、依从性以及与护理相关的成本障碍。

This statement is intended to complement existing clinical practice guidelines by synthesizing evolving data, clarifying areas of uncertainty, and supporting individualized, patient-centered decision making.

本声明旨在通过综合不断发展的数据、阐明不确定领域，并支持个体化、以患者为中心的决策，以补充现有的临床实践指南。

By addressing both evidence and implementation challenges, this document aims to improve the appropriate and equitable use of DOACs across the spectrum of thrombotic disease.

通过解决证据和实施挑战，本文件旨在改善DOACs在血栓性疾病谱系中的适当和公平使用。