Capranzano Piera, Miccichè Eligio, D'Urso Lucia, Privitera Fiorella, Tamburino Corrado
Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
Expert Rev Cardiovasc Ther. 2013 Aug;11(8):959-73. doi: 10.1586/14779072.2013.818819. Epub 2013 Aug 19.
For decades, warfarin has remained the standard oral anticoagulation for stroke prevention in atrial fibrillation (AF). Three novel oral anticoagulants (NOACs) have been recently approved for stroke prevention in non-valvular AF: dabigatran, rivaroxaban and apixaban. Better pharmacological and clinical profiles make these newcomers a preferable alternative over warfarin. Current AF guidelines do not endorse NOACs over warfarin, or one NOAC over another. Indeed, choice of the anticoagulation regimen should be personalized based on the relative efficacy and safety of different agents across subgroups stratified by thrombotic and bleeding risk, as well as on other clinical factors, including anticoagulation control on warfarin, drug interactions, compliance and need for coagulation monitoring. This review appraises i) the randomized evidence on approved NOACs versus warfarin in AF across subgroups stratified by risk factors of stroke and bleeding and by the anticoagulation level reached on warfarin; and ii) clinical factors impacting on the anticoagulation regimen selection.
几十年来，华法林一直是心房颤动（AF）患者预防卒中的标准口服抗凝药物。最近，三种新型口服抗凝剂（NOACs）已被批准用于非瓣膜性AF患者的卒中预防：达比加群、利伐沙班和阿哌沙班。更好的药理学和临床特性使这些新药成为比华法林更优的选择。目前的AF指南并未认可NOACs优于华法林，也未表明一种NOAC优于另一种。实际上，抗凝治疗方案的选择应个体化，需基于不同药物在根据血栓形成和出血风险分层的亚组中的相对疗效和安全性，以及其他临床因素，包括华法林的抗凝控制情况、药物相互作用、依从性和凝血监测需求。本综述评估了：i）在根据卒中和出血风险因素以及华法林达到的抗凝水平分层的亚组中，已批准的NOACs与华法林用于AF的随机对照证据；ii）影响抗凝治疗方案选择的临床因素。
