Department of Pharmacy, Maine Medical Center, Portland, ME, USA.
J Thromb Haemost. 2011 Mar;9(3):441-9. doi: 10.1111/j.1538-7836.2010.04179.x.
Stroke prevention in atrial fibrillation is of paramount importance given its associated morbidity and mortality. The many challenges of warfarin limit its effective use in real-world clinical practice. We are entering an exciting therapeutic era as new classes of anticoagulants, including direct thrombin inhibitors, factor Xa inhibitors and novel vitamin K antagonists, are being evaluated for possible use in this patient population. If proven to be as efficacious as warfarin and safer, expanded use of these novel agents to lower risk subgroups may be justified. It is imperative that providers be aware of the many advantages and potential challenges posed by use of these novel agents in routine clinical care. An understanding of individual pharmacokinetic profiles and potential drug-drug and drug-disease interactions will translate into improved effectiveness in real-world practice.
鉴于房颤相关的发病率和死亡率，预防卒中至关重要。华法林的诸多挑战限制了其在真实临床实践中的有效应用。随着新型抗凝药物（包括直接凝血酶抑制剂、Xa 因子抑制剂和新型维生素 K 拮抗剂）在该患者人群中的应用价值得到评估，我们即将进入一个激动人心的治疗时代。如果这些新型药物被证明与华法林同样有效且更安全，那么将其扩大应用于风险较低的亚组可能是合理的。临床医生务必了解这些新型药物在常规临床护理中的诸多优势和潜在挑战。了解个体药代动力学特征以及潜在的药物-药物和药物-疾病相互作用，将转化为真实世界实践中的疗效提高。
