Department of Cardiology, University Hospital Jean Minjoz, EA3920, Boulevard Fleming, 25000 Besançon, France.
Europace. 2012 Mar;14(3):312-24. doi: 10.1093/europace/eur263.
Atrial fibrillation (AF) is strongly associated with cardioembolic stroke, and thromboprophylaxis is an established means of reducing stroke risk in patients with AF. Oral vitamin K antagonists such as warfarin have been the mainstay of therapy for stroke prevention in patients with AF. However, they are associated with a number of limitations, including excessive bleeding when not adequately controlled. Antiplatelet agents do not match vitamin K antagonists in terms of their preventive efficacy. Dual-antiplatelet therapy (clopidogrel and acetylsalicylic acid) or combined antiplatelet-vitamin K antagonist therapy in AF has also failed to provide convincing evidence of their additional benefit over vitamin K antagonists alone. Novel oral anticoagulants, including the direct thrombin inhibitor dabigatran and direct Factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban, have now been approved or are currently in late-stage clinical development in AF. These newer agents may provide a breakthrough in the optimal management of stroke risk.
心房颤动（AF）与心源性脑卒密切相关，血栓预防是降低 AF 患者卒中风险的既定手段。口服维生素 K 拮抗剂，如华法林，一直是 AF 患者预防卒中的主要治疗方法。然而，它们存在许多局限性，包括在控制不充分时会出现过度出血。抗血小板药物在预防效果方面与维生素 K 拮抗剂无法相提并论。双重抗血小板治疗（氯吡格雷和乙酰水杨酸）或联合抗血小板-维生素 K 拮抗剂治疗在 AF 中的疗效也未能提供令人信服的证据表明其优于单独使用维生素 K 拮抗剂。新型口服抗凝剂，包括直接凝血酶抑制剂达比加群和直接 Xa 因子抑制剂如利伐沙班、阿哌沙班和依度沙班，现已在 AF 中获得批准或处于晚期临床开发阶段。这些新的药物可能为优化卒中风险管理提供突破。
