General Practice & Primary Care Research Unit, Department of Public Health & Primary Care, Forvie Site, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0SR, UK.
Drugs Aging. 2010 Nov 1;27(11):859-70. doi: 10.2165/11538620-000000000-00000.
Atrial fibrillation confers a 5-fold increase in risk of stroke. A number of drugs aimed at reducing this risk have been tested in randomized controlled trials. These include antiplatelet agents (singly and in combination); anticoagulants, including vitamin K antagonists and direct thrombin inhibitors; and anticoagulants with antiplatelet agents. Guidelines recommend that the choice of therapy should be determined by an assessment of underlying risk of stroke, with antiplatelet agents being indicated for people at low risk of stroke and anticoagulants for those at higher risk. The treatment decision is complicated by considerations of haemorrhage risk, with factors that increase risk of stroke also associated with increased risk of haemorrhage. Evidence from recent studies confirms that patients at high risk of stroke should be treated with anticoagulants, including elderly patients, provided that good international normalized ratio (INR) control can be maintained. Newer agents may enable a higher proportion of patients at high risk of stroke to be treated with anticoagulants than is currently the case. Decision making about people at moderate risk of stroke is less clear cut, and a choice of either an antiplatelet agent or an anticoagulant can be justified. For people at low risk of stroke, anticoagulation is not indicated.
心房颤动使中风风险增加 5 倍。已经在随机对照试验中测试了许多旨在降低这种风险的药物。这些药物包括抗血小板药物（单独使用和联合使用）；抗凝剂，包括维生素 K 拮抗剂和直接凝血酶抑制剂；以及具有抗血小板作用的抗凝剂。指南建议，治疗选择应根据中风风险的评估来确定，抗血小板药物适用于中风风险较低的人群，抗凝剂适用于中风风险较高的人群。出血风险的考虑使治疗决策变得复杂，增加中风风险的因素也与增加出血风险相关。最近的研究证据证实，只要能够保持良好的国际标准化比值（INR）控制，高中风风险的患者应接受抗凝治疗，包括老年患者。新型药物可能使更多高中风风险的患者能够接受抗凝治疗，而不是目前的情况。对于中风风险中等的患者，决策就不那么明确了，抗血小板药物或抗凝剂的选择都是合理的。对于中风风险较低的患者，不建议抗凝。
