Department of Cardiology, Hospital Infanta Sofia, Madrid.
Cardiovasc Ther. 2010 Oct;28(5):295-301. doi: 10.1111/j.1755-5922.2010.00216.x. Epub 2010 Aug 16.
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance found in clinical practice, increasing in prevalence with age. AF is often associated with structural heart disease, although a significant proportion has no detectable heart disease. In the last 2 decades, there has been an increase of 66% in hospitalizations for AF, and it is an extremely costly public health problem. AF is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality. In fact, the mortality rate in patients with AF is about double that of patients in normal sinus rhythm. Antithrombotic therapy is recommended for all patients with AF to prevent thromboembolism, except those with lone AF or contraindications. Selection of the antithrombotic agent should be based upon the absolute risks of stroke and bleeding and the relative risk and benefit for a given patient. However, despite oral anticoagulation with vitamin K antagonists (warfarin or acenocoumarol) some patients still have thromboembolic events. Furthermore, for the majority of patients, international normalized ratio (INR) monitoring may be an inconvenience. This is why new anticoagulants, such as the direct thrombin inhibitors, are being investigated. The results of the RE-LY trial have recently been published. In this study, in a population of patients with AF, dabigatran at 110 mg b.i.d was associated with stroke and systemic embolism rates similar to those associated with warfarin, and with lower rates of major hemorrhage. However, when dabigatran was administered at a dose of 150 mg, lower rates of stroke and systemic embolism and similar rates of major hemorrhage were found compared with warfarin. The aim of this review is to update information on the prevention of thromboembolic events in patients with AF and how dabigatran may change daily clinical practice.
心房颤动（AF）是临床实践中最常见的持续性心律失常，随着年龄的增长而患病率增加。AF 常与结构性心脏病相关，尽管有相当一部分没有可检测到的心脏病。在过去的 20 年中，因 AF 住院的人数增加了 66%，这是一个极其昂贵的公共卫生问题。AF 与长期中风、心力衰竭和全因死亡率增加有关。事实上，AF 患者的死亡率是窦性心律正常患者的两倍左右。除了孤立性 AF 或有禁忌症的患者外，所有 AF 患者均推荐使用抗血栓治疗来预防血栓栓塞。抗血栓药物的选择应基于中风和出血的绝对风险以及对特定患者的相对风险和益处。然而，尽管使用维生素 K 拮抗剂（华法林或醋硝香豆素）进行口服抗凝治疗，一些患者仍会发生血栓栓塞事件。此外，对于大多数患者而言，国际标准化比值（INR）监测可能会带来不便。这就是为什么正在研究新型抗凝剂，如直接凝血酶抑制剂的原因。RE-LY 试验的结果最近已经公布。在这项研究中，在 AF 患者人群中，每日两次给予 110mg 达比加群与华法林相关的中风和全身性栓塞发生率相似，且大出血发生率较低。然而，当达比加群以 150mg 的剂量给药时，与华法林相比，中风和全身性栓塞的发生率较低，而大出血的发生率相似。本综述的目的是更新有关预防 AF 患者血栓栓塞事件的信息，以及达比加群如何改变日常临床实践。
