新型口服抗凝剂在房颤治疗中的应用。

U. Ansari, M. Behnes, C. Fastner, I. Akin
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引用次数: 0

摘要

房颤已知与缺血性卒中和全身性栓塞的风险增加有关。在使用各种风险计算评分进行分层后,患者被传统处方阿司匹林或传统维生素K拮抗剂形式的抗凝剂。使用华法林已被证明可以减少缺血性中风的发生;然而,它的使用有一些限制。需要严格的抗凝监测,以维持由2到3之间的国际标准化比值(INR)测量的狭窄治疗范围就是其中之一。在临床实践中,患者在不到三分之二的时间内处于治疗范围内,此外,它的使用与大出血的显著风险相关。新型口服抗凝剂的出现标志着抗凝治疗进入了一个新的时代。直接凝血酶抑制剂和Xa因子抑制剂的使用已经证明了有利的出血概况,同时与VKA相比类似或更有效。早期研究表明,卒中或全身性栓塞的发生率显著降低,全因死亡率降低。在这篇综述中,我们讨论了新型抗凝剂与华法林在房颤患者中的临床获益和安全性的证据,以及它们使用的试用指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Use of Novel Oral Anticoagulants in Atrial Fibrillation.
Atrial fibrillation is known to be associated with an increased risk of ischaemic stroke and systemic embolism. After stratification using various risk calculation scores, patients were traditionally prescribed anticoagulants in the form of Aspirin or the traditional Vitamin K Antagonists. The use of Warfarin has proven to reduce incidents of ischaemic stroke; however its use has several limitations. The necessity for strict anticoagulation monitoring so as to maintain the narrow therapeutic range as measured by the international normalized ratio (INR) between 2 and 3 is one of these. In clinical practice, patients are within the therapeutic range lesser than two-thirds of the time and furthermore, its use is associated with a significant risk of major bleeding. The advent of Novel oral Anticoagulants marks a new era in anticoagulant therapy. The use of direct thrombin inhibitors and Factor Xa inhibitors has documented a favorable bleeding profile while being similarly or more efficacious when compared to VKA. Early studies indicate a significant reduction in the composite of stroke or systemic embolism and lowering of all-cause mortality. In this review we discuss the evidence for the clinical benefit and safety of the novel anticoagulants versus warfarin among patients with atrial fibrillation and probationary guidelines towards their use.
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