Heartcenter, Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC, Amsterdam, the Netherlands,
Neth Heart J. 2013 Nov;21(11):480-4. doi: 10.1007/s12471-013-0473-0.
In patients with nonvalvular atrial fibrillation, oral anticoagulation with the vitamin K antagonists acenocoumarol, phenprocoumon and warfarin reduces the risk of stroke by more than 60 %, whereas single or double antiplatelet therapy is much less effective and sometimes associated with a similar bleeding risk as vitamin K antagonists. Besides bleeding, and intracranial haemorrhage in particular, INR monitoring remains the largest drawback of vitamin K antagonists. In the last decade oral agents have been developed that directly block the activity of thrombin (factor IIa), as well as drugs that directly inhibit activated factor X (Xa), which is the first compound in the final common pathway to the activation of thrombin. These agents have been approved for stroke prevention in atrial fibrillation and are now reimbursed under a national guideline for their safe use. They have advantages in that they do not need monitoring and have a fast onset and offset of action, but lack an established specific antidote. This survey addresses the role of modern anticoagulation for stroke prevention in atrial fibrillation.
在非瓣膜性心房颤动患者中，口服抗凝剂维生素 K 拮抗剂（如华法林）可使卒中风险降低 60%以上，而单一或双联抗血小板治疗的效果要差得多，且有时与维生素 K 拮抗剂相关的出血风险相似。除出血外，INR 监测仍是维生素 K 拮抗剂的最大缺点。在过去十年中，已经开发出了直接抑制凝血酶（因子 IIa）活性的口服药物，以及直接抑制激活的因子 X（Xa）的药物，Xa 是最终共同途径激活凝血酶的第一个化合物。这些药物已被批准用于预防心房颤动中的卒中，并且现在根据国家指南安全使用这些药物。它们具有不需要监测、起效快、作用时间短的优点，但缺乏已建立的特异性解毒剂。本调查探讨了现代抗凝治疗在预防心房颤动卒中中的作用。
