心房颤动的卒中预防：现状与近期方向。

Stroke prevention in atrial fibrillation: current status and near-future directions.

机构信息

Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio University, Chieti, Italy.

出版信息

Am J Med. 2011 Sep;124(9):793-9. doi: 10.1016/j.amjmed.2011.03.013.

DOI:10.1016/j.amjmed.2011.03.013

Abstract

Prevention of atrial fibrillation-related stroke is an important part of atrial fibrillation management. However, stroke risk is not homogeneous and varies with associated morbidities and risk factors. Risk stratification schemes have been developed that categorize patients' stroke risk into classes based on a combination of risk factors. According to the calculated level of risk, guidelines recommend patients with atrial fibrillation receive antithrombotic therapy either as a vitamin K antagonist or aspirin. Despite recommendations, however, many patients with atrial fibrillation do not receive adequate thromboprophylaxis. We will discuss some of the underlying reasons, in part related to the drawbacks associated with vitamin K antagonists. These highlight the need for new anticoagulants in atrial fibrillation. The novel oral anticoagulants in development may overcome some of the limitations of vitamin K antagonists and address their underuse and safety concerns.

摘要

预防房颤相关卒中是房颤管理的重要组成部分。然而，卒中风险并非均匀分布，且因相关合并症和危险因素而异。风险分层方案已经制定，根据危险因素的组合，将患者的卒中风险分为不同类别。根据计算出的风险水平，指南建议房颤患者接受抗血栓治疗，要么使用维生素 K 拮抗剂，要么使用阿司匹林。然而，尽管有这些推荐，许多房颤患者并未接受足够的血栓预防治疗。我们将讨论其中一些潜在的原因，部分原因与维生素 K 拮抗剂相关的缺点有关。这些问题突显了在房颤中需要新型抗凝剂。正在开发的新型口服抗凝剂可能克服维生素 K 拮抗剂的一些局限性，并解决其使用不足和安全性问题。