Littrell Rachel, Flaker Greg
University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA.
Expert Rev Cardiovasc Ther. 2012 Feb;10(2):143-9. doi: 10.1586/erc.11.187.
Until recently, pharmaceutical options for stroke prevention in atrial fibrillation were restricted to aspirin or vitamin K antagonist therapy. In recent years development has been underway for alternatives. Apixaban, a direct Factor Xa inhibitor, is orally dosed, target selective and has few known drug or food interactions. As such, it is a member of a new generation of anticoagulants expected to revolutionize the way we approach anticoagulation for stroke prevention in atrial fibrillation. Apixaban has been studied in Phase II and Phase III trials for a variety of indications. The AVERROES trial established apixaban as superior to aspirin for stroke reduction in patients with atrial fibrillation for whom vitamin K antagonist therapy is unsuitable. The recent ARISTOTLE trial found apixaban to be superior to warfarin for stroke prevention in a wide range of patients with atrial fibrillation, with significantly lower bleeding risk, and lower risk of all-cause mortality.
直到最近，心房颤动中风预防的药物选择还仅限于阿司匹林或维生素K拮抗剂疗法。近年来一直在研发替代药物。阿哌沙班是一种直接的Xa因子抑制剂，口服给药，具有靶点选择性，已知的药物或食物相互作用较少。因此，它是新一代抗凝剂的一员，有望彻底改变我们预防心房颤动中风的抗凝方式。阿哌沙班已在II期和III期试验中针对多种适应症进行了研究。AVERROES试验证实，对于不适合使用维生素K拮抗剂治疗的心房颤动患者，阿哌沙班在降低中风风险方面优于阿司匹林。最近的ARISTOTLE试验发现，在广泛的心房颤动患者中，阿哌沙班在预防中风方面优于华法林，出血风险显著降低，全因死亡率风险也更低。
