Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
J Am Coll Cardiol. 2010 Dec 14;56(25):2067-76. doi: 10.1016/j.jacc.2010.09.017.
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and a major risk factor for ischemic stroke. Antithrombotic therapy using aspirin or vitamin K antagonists (VKA) is currently prescribed for prevention for ischemic stroke in patients with AF. A narrow therapeutic range and the need of regular monitoring of its anticoagulatory effect impair effectiveness and safety of VKA, causing a need for alternative anticoagulant drugs. Recently developed anticoagulants include direct thrombin antagonists such as dabigatran or factor Xa inhibitors such as rivaroxaban, apixaban, betrixaban, and edoxaban. Currently, data from a phase III clinical trial are available for dabigatran only, which show the direct thrombin antagonist to be at least noninferior in efficacy to VKA for the prevention of stroke and systemic embolism in patients with AF. This review focuses on current advances in the development of directly acting oral anticoagulant drugs and their potential to replace the VKA class of drugs in patients with AF.
心房颤动（AF）是最常见的心律失常，也是缺血性卒中的主要危险因素。目前，抗血小板治疗或维生素 K 拮抗剂（VKA）用于预防 AF 患者的缺血性卒中。VKA 的治疗窗较窄，需要定期监测其抗凝效果，这降低了其有效性和安全性，导致需要替代抗凝药物。最近开发的抗凝剂包括直接凝血酶拮抗剂，如达比加群，或因子 Xa 抑制剂，如利伐沙班、阿哌沙班、贝曲沙班和依度沙班。目前，只有达比加群的 III 期临床试验数据可用，这些数据表明，直接凝血酶拮抗剂在预防 AF 患者的卒中和全身性栓塞方面的疗效至少不劣于 VKA。本综述重点介绍了直接作用的口服抗凝药物的最新进展及其在 AF 患者中替代 VKA 类药物的潜力。
