University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, UK.
Stroke. 2011 Nov;42(11):3316-22. doi: 10.1161/STROKEAHA.111.617886. Epub 2011 Oct 13.
Worldwide, atrial fibrillation is the most common arrhythmia, and its symptoms and sequelae cause an enormous burden to patients and health systems. Stroke is associated with the greatest mortality and morbidity in patients with atrial fibrillation (AF). The last decade has seen great advances in scientific and therapeutic approaches to AF.
This review considers recent changes to stroke prevention, particularly focusing on new anticoagulants, antiarrhythmic drugs, and devices as well as future research directions.
A semi-systematic literature review was performed using search terms "atrial fibrillation" and "novel therapy" within the PubMed database from 2005 to 2011. The area of greatest progress has been novel anticoagulants with direct thrombin inhibitors and factor Xa inhibitors. Dabigatran is the only novel agent currently licensed for use in AF patients, but with several trials of novel agents pending and favorable results so far, other agents are likely to follow. Novel antiarrhythmic drugs, left atrial appendage occlusion, and upstream therapies all represent potential new approaches but require further research.
Novel anticoagulant and arrhythmic agents are changing treatment guidelines and choices available to both patients and clinicians for stroke prevention in AF, but bring new considerations and long-term data are required, because most patients will require lifelong therapy. Future research must incorporate patient values and preferences, because novel therapies can potentially give very different treatment options, which must be explained for patients to make informed choices.
在全球范围内，心房颤动是最常见的心律失常，其症状和后果给患者和医疗系统带来了巨大的负担。在心房颤动（AF）患者中，中风与最大的死亡率和发病率相关。过去十年中，AF 的科学和治疗方法取得了重大进展。
本篇综述考虑了中风预防的最新变化，特别是新的抗凝剂、抗心律失常药物和设备以及未来的研究方向。
使用 PubMed 数据库中的搜索词“心房颤动”和“新疗法”，对 2005 年至 2011 年的文献进行了半系统的文献回顾。进展最大的领域是具有直接凝血酶抑制剂和因子 Xa 抑制剂的新型抗凝剂。达比加群是目前唯一获准用于 AF 患者的新型药物，但由于多项新型药物试验正在进行中，且迄今为止结果良好，因此其他药物可能会跟进。新型抗心律失常药物、左心耳封堵术和上游治疗都代表了潜在的新方法，但需要进一步研究。
新型抗凝剂和抗心律失常药物正在改变 AF 患者中风预防的治疗指南和可供患者和临床医生选择的治疗方案，但需要新的考虑因素和长期数据，因为大多数患者将需要终身治疗。未来的研究必须结合患者的价值观和偏好，因为新型疗法可能会提供非常不同的治疗选择，必须向患者解释清楚，以便他们做出明智的选择。
