Szapary László, Fehér Gergely, Bosnyák Edit, Deli Gabriella, Csécsei Péter
Pécsi Tudományegyetem, KK, Neurológiai Klinika, Pécs.
Ideggyogy Sz. 2013 May 30;66(5-6):165-74.
Non-valvular AF is the most common cardiac arrhytmia. Its incidence increases with age. AF is an independent risk factor for ischaemic stroke, representing a five times higher risk for it, associated with a high mortality rate. Beside AF, there are several other risk factors which influence the risk of stroke. Stroke risk calculator can be used to assess the risk of patient having a stroke. The most endangered group of patients with AF are those who have already suffered from cerebrovascular event. The only effective medication for prevention of stroke due to AF had been the application of vitamin K antagonists (VKA) which considerably decrease the rate of ischaemic event in a patient with AF providing that the INR is in the therapeutic range. VKA have several limitations of use in clinical practice and the fear of bleeding complications results an underusing of these drugs. Only 50% of all patients treated with VKA reaches the therapeutic range of INR. The breakthrough of prevention of stroke in recent years is undisputedly the coming out of novel oral anticoagulants (NOACs, thrombin and Xa-factor inhibitors). Recent studies suggest that these novel drugs prove the same efficacy as VKA drugs, furthermore dabigatran in a dose of 2 x 150 mg or apixaban in 2 x 5 mg was statistically superior to warfarin in the prevention of stroke. NOACs have shown a large reduction in intracranial hemorrhage compared with warfarin. They are given as a fixed dose and do not require persistent monitoring making them much more convenient. NOACs at guidelines of European Society of Cardiology act as a preferable drugs in case of ischaemic stroke with AF Probably the extended use of NOACs in clinical practice will be the mainstream of stroke prevention in the future.
非瓣膜性房颤是最常见的心律失常。其发病率随年龄增长而增加。房颤是缺血性卒中的独立危险因素，发生缺血性卒中的风险高出五倍，且死亡率高。除房颤外，还有其他几个影响卒中风险的因素。卒中风险计算器可用于评估患者发生卒中的风险。房颤患者中最危险的群体是那些已经发生过脑血管事件的患者。预防房颤所致卒中的唯一有效药物一直是应用维生素K拮抗剂（VKA），前提是国际标准化比值（INR）处于治疗范围内，这可显著降低房颤患者的缺血性事件发生率。VKA在临床应用中有几个局限性，对出血并发症的担忧导致这些药物使用不足。接受VKA治疗的所有患者中只有50%达到INR的治疗范围。近年来预防卒中的突破无疑是新型口服抗凝药（NOACs，凝血酶和Xa因子抑制剂）的出现。最近的研究表明，这些新药与VKA药物具有相同的疗效，此外，2×150mg剂量的达比加群或2×5mg剂量的阿哌沙班在预防卒中方面在统计学上优于华法林。与华法林相比，NOACs的颅内出血发生率大幅降低。它们以固定剂量给药，不需要持续监测，使用起来更加方便。根据欧洲心脏病学会指南，在房颤合并缺血性卒中的情况下，NOACs是首选药物。在临床实践中广泛使用NOACs可能将成为未来卒中预防的主流。
