Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Postgrad Med. 2011 Mar;123(2):27-35. doi: 10.3810/pgm.2011.03.2260.
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, yet because AF can often be intermittent or lacking in overt symptoms, its prevalence is underestimated, and it may be diagnosed only incidentally. Because AF is a potent ischemic stroke risk factor and stroke rates are similar for paroxysmal, persistent, and permanent AF, all AF types require prompt management. This involves identifying and treating underlying causative factors, then implementing a "rate-control" or "rhythm-control" strategy. Regardless of approach, concomitant antithrombotic therapy for stroke risk reduction is recommended. Antithrombotic agent choice (acetylsalicylic acid or warfarin) depends on level of stroke risk; this review covers both the CHADS2 and CHA2DS2-VASc risk stratification schemes. Warfarin provides effective ischemic stroke prophylaxis but has numerous drawbacks, including a narrow therapeutic range, unpredictable pharmacokinetics, slow on-/offset of action, and multiple food and drug interactions. New oral anticoagulants that lack many of these drawbacks are in development. Here we review these drugs for stroke prevention in AF.
心房颤动（AF）是最常见的持续性心律失常，但由于 AF 通常是间歇性的，或缺乏明显的症状，其患病率被低估了，而且可能只是偶然诊断出来。由于 AF 是缺血性中风的一个强有力的危险因素，而且阵发性、持续性和永久性 AF 的中风发生率相似，因此所有类型的 AF 都需要及时治疗。这包括确定和治疗潜在的病因，并实施“控制心率”或“控制节律”策略。无论采用哪种方法，都建议同时进行抗血栓治疗以降低中风风险。抗血栓药物的选择（乙酰水杨酸或华法林）取决于中风风险水平；这篇综述涵盖了 CHADS2 和 CHA2DS2-VASc 风险分层方案。华法林能有效预防缺血性中风，但有许多缺点，包括治疗窗窄、药代动力学不可预测、作用起效和消除缓慢，以及多种食物和药物相互作用。目前正在开发缺乏这些缺点的新型口服抗凝剂。在这里，我们将对这些药物在 AF 中的中风预防作用进行综述。
