Martí-Fàbregas J, Delgado-Mederos R, Mateo J
Unidad de Enfermedades Vasculares Cerebrales, Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Neurologia. 2012 Mar;27 Suppl 1:27-32. doi: 10.1016/S0213-4853(12)70005-1.
Vitamin K antagonists have been shown to be effective in the primary and secondary prevention of systemic and cerebral emboli in patients with cardiac causes of embolism, especially atrial fibrillation. The reduced risk of stroke is greater in secondary prevention, although this reduction is accompanied by an inherent risk of hemorrhagic complications, among which cerebral hemorrhage is especially serious. The therapeutic window of these agents is limited and the best benefit/risk profile is obtained with an INR of between 2 and 3. The anticoagulant effect obtained shows marked variability, requiring frequent clinical and laboratory monitoring of the treatment. The introduction of oral anticoagulants that would aid the administration of these agents with equal or greater efficacy and lower risk is required.
维生素K拮抗剂已被证明在患有栓塞性心脏病因（尤其是心房颤动）的患者中，对全身和脑栓塞的一级和二级预防有效。在二级预防中，中风风险降低幅度更大，尽管这种降低伴随着出血并发症的固有风险，其中脑出血尤为严重。这些药物的治疗窗有限，国际标准化比值（INR）在2至3之间时可获得最佳的效益/风险比。所获得的抗凝效果显示出显著的变异性，需要对治疗进行频繁的临床和实验室监测。需要引入口服抗凝剂，以帮助更有效、更低风险地使用这些药物。
