Di Pasquale Giuseppe, Riva Letizia
U.O.di Cardiologia, Ospedale Maggiore, Bologna.
G Ital Cardiol (Rome). 2011 Sep;12(9):556-65. doi: 10.1714/926.10169.
Warfarin has been the effective treatment in the prophylaxis of cardioembolism, in particular in patients with atrial fibrillation, for more than 50 years. Nevertheless, many patients with atrial fibrillation are not currently treated because of the numerous limits of oral anticoagulation and in those treated the quality of anticoagulation is often poor. Novel oral anticoagulant drugs, the direct thrombin antagonist dabigatran and factor Xa inhibitors such as rivaroxaban, apixaban, edoxaban, and betrixaban are more predictable and convenient anticoagulants in comparison with warfarin, mainly because of the non-requirement of regular laboratory monitoring and dose adjustments. Current data from phase III clinical trials are available for dabigatran, rivaroxaban and apixaban, which show to be at least noninferior in efficacy to warfarin for the prevention of stroke in patients with atrial fibrillation. This review focuses on the potential of novel anticoagulants to replace warfarin in patients with atrial fibrillation. Also the place in therapy and the potential limitations of the new agents in clinical practice represent important issues to be considered. The promise of new oral anticoagulants gives us the hope that warfarin will finally be replaced in a near future, but more importantly that anticoagulant undertreatment of atrial fibrillation will be partially overcome.
五十多年来，华法林一直是预防心脏栓塞的有效治疗药物，尤其是对心房颤动患者。然而，由于口服抗凝治疗存在诸多局限性，目前许多心房颤动患者并未接受治疗，而且在接受治疗的患者中，抗凝质量往往较差。与华法林相比，新型口服抗凝药物，即直接凝血酶拮抗剂达比加群以及因子Xa抑制剂，如利伐沙班、阿哌沙班、依度沙班和贝曲沙班，是更具可预测性且更方便的抗凝药物，主要原因是无需定期进行实验室监测和剂量调整。目前有达比加群、利伐沙班和阿哌沙班的III期临床试验数据，这些数据表明，在预防心房颤动患者中风方面，它们的疗效至少不劣于华法林。本综述重点关注新型抗凝药物在心房颤动患者中取代华法林的潜力。此外，新药物在治疗中的地位以及在临床实践中的潜在局限性也是需要考虑的重要问题。新型口服抗凝药物带来的希望让我们期待，在不久的将来华法林最终将被取代，但更重要的是，心房颤动抗凝治疗不足的情况将得到部分改善。
