Lang N N, Connelly D T
Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, UK.
J R Coll Physicians Edinb. 2013;43(2):151-8. doi: 10.4997/JRCPE.2013.213.
The most significant complication of atrial fibrillation (AF) is thromboembolic stroke. Furthermore, the consequences of AF-related stroke tend to be more severe than those of other aetiologies. The need for safe, effective and convenient anticoagulation is clear. Warfarin is the current mainstay of treatment but its prescription and use remains sub-optimal, despite clear evidence and guidance to support its use. Many patients taking warfarin spend a significant amount of time subtherapeutically anticoagulated and the requirement for regular monitoring of warfarin's anticoagulant activity is both inconvenient and costly. Novel oral anticoagulants promise more predictable and convenient anticoagulation. They have potential superiority over warfarin for preventing thromboembolic stroke and appear to be associated with fewer haemorrhagic effects. Understanding the important background to the novel agents presents an opportunity to tailor anticoagulant treatment to the individual. This should allow a greater proportion of the eligible population access to effective anticoagulation. Furthermore, it should reduce their exposure to the risk of both thromboembolic and haemorrhagic stroke and their potentially devastating consequences.
心房颤动（AF）最严重的并发症是血栓栓塞性中风。此外，与AF相关的中风后果往往比其他病因导致的中风更严重。显然需要安全、有效且方便的抗凝治疗。华法林是目前的主要治疗药物，但其处方和使用仍未达到最佳状态，尽管有明确的证据和指南支持其使用。许多服用华法林的患者在抗凝治疗未达治疗水平的状态下花费大量时间，并且定期监测华法林抗凝活性的要求既不方便又昂贵。新型口服抗凝药有望实现更可预测且方便的抗凝效果。它们在预防血栓栓塞性中风方面可能优于华法林，并且似乎出血副作用更少。了解这些新型药物的重要背景为根据个体情况调整抗凝治疗提供了契机。这应能使更大比例的符合条件人群获得有效的抗凝治疗。此外，这应能减少他们面临血栓栓塞性和出血性中风风险及其潜在严重后果的可能性。
