Division of Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Neurol Clin. 2013 Aug;31(3):659-75. doi: 10.1016/j.ncl.2013.03.001.
New oral anticoagulants have been found to be as efficacious as warfarin and safer in terms of intracranial bleeding. All patients with nonvalvular atrial fibrillation should receive antithrombotic therapy for stroke prevention. For those at low risk, antiplatelet therapy is probably sufficient. For those at intermediate or high risk, anticoagulation is superior to antiplatelet therapy. Four oral anticoagulants are currently approved for stroke and systemic embolism prevention in atrial fibrillation: warfarin, dabigatran, rivaroxaban, and apixaban. Management of bleeding complications while on the new agents remains an area of concern and management is based on anecdotal experience and observational studies.
新型口服抗凝剂在预防颅内出血方面与华法林同样有效且安全性更高。所有非瓣膜性心房颤动患者均应接受抗血栓治疗以预防卒中。对于低危患者，抗血小板治疗可能就足够了。对于中危或高危患者，抗凝治疗优于抗血小板治疗。目前有 4 种口服抗凝剂被批准用于房颤的卒中及全身性栓塞预防：华法林、达比加群、利伐沙班和阿哌沙班。新型抗凝剂相关出血并发症的管理仍然是一个关注的领域，管理主要基于经验和观察性研究。
