Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
Nat Rev Cardiol. 2010 Mar;7(3):149-54. doi: 10.1038/nrcardio.2009.235.
Warfarin reduces the risk of stroke in atrial fibrillation by around 60%, while antiplatelet therapy is much less effective. Bleeding is, however, a notable adverse effect with warfarin. Another major drawback of warfarin is the need for frequent clotting assessment. Oral agents have been developed that directly inhibit the activity of thrombin (factor IIa), as well as drugs that directly block activated factor X (factor Xa), which is the first enzyme in the final common pathway to the activation of thrombin. These drugs have fast onset and offset of action and anticoagulation does not seem to need monitoring. These new agents for stroke prevention in atrial fibrillation are being investigated in ongoing phase III trials. In one of these trials an oral thrombin blocker has so far shown superiority to warfarin in efficacy and safety. In this Review, I address the potential of modern oral anticoagulants to improve stroke prevention in atrial fibrillation.
华法林可使房颤患者发生中风的风险降低约 60%，而抗血小板治疗的效果要差得多。然而，华法林会引起明显的出血不良反应。华法林的另一个主要缺点是需要频繁进行凝血评估。现已开发出一些口服药物，可直接抑制凝血酶（因子 IIa）的活性，以及直接阻断激活的因子 X（因子 Xa）的药物，因子 Xa 是凝血酶激活的最终共同途径中的第一个酶。这些药物起效和失效迅速，似乎不需要监测抗凝作用。这些用于房颤中风预防的新型药物正在进行的 III 期临床试验中进行研究。在其中一项试验中，一种口服凝血酶抑制剂在疗效和安全性方面迄今已显示优于华法林。在这篇综述中，我探讨了新型口服抗凝剂在改善房颤中风预防方面的潜力。
