Preventive Cardiology, CGH Medical Center, Sterling, IL61081, USA.
Postgrad Med. 2013 May;125(3):155-61. doi: 10.3810/pgm.2013.05.2670.
Patients with atrial fibrillation are at an increased risk for stroke. Anticoagulation therapy has been shown to significantly reduce the risk for stroke in these patients. Warfarin therapy is effective at reducing the risk for thromboembolic events, but requires frequent monitoring of its anticoagulation effect using the international normalized ratio and significantly increases the risk for hemorrhagic events, including intracranial hemorrhage. Novel oral anticoagulants provide simpler, effective stroke prophylaxis in patients with atrial fibrillation. These drugs include dabigatran (a direct thrombin inhibitor) as well as rivaroxaban and apixaban (factor Xa inhibitors). The new anticoagulants have rapid onset of effect; their anticoagulatory effect is stable, predictable, and dose related; and they do not require monitoring of anticoagulation effect using the international normalized ratio. The pharmacology, clinical efficacy, and potential adverse effects of these drugs in patients with atrial fibrillation are reviewed herein.
心房颤动患者发生中风的风险增加。抗凝治疗已被证明可显著降低这些患者发生中风的风险。华法林治疗可有效降低血栓栓塞事件的风险，但需要使用国际标准化比值（INR）频繁监测其抗凝效果，并显著增加出血事件的风险，包括颅内出血。新型口服抗凝药物为心房颤动患者提供了更简单、有效的中风预防。这些药物包括达比加群（直接凝血酶抑制剂）以及利伐沙班和阿哌沙班（Xa 因子抑制剂）。新型抗凝剂起效迅速；其抗凝效果稳定、可预测且与剂量相关；并且不需要使用 INR 监测抗凝效果。本文综述了这些药物在心房颤动患者中的药理学、临床疗效和潜在不良反应。
