Internal Medicine, Vimercate Hospital, Azienda Ospedaliera di Desio e Vimercate, Italy.
Thromb J. 2014 Feb 18;12(1):5. doi: 10.1186/1477-9560-12-5.
Vitamin K Antagonists (VKAs) are widely used in clinical practice and nearly 1% of the entire population receives oral anticoagulation at least once in life. However, the rate of prescription of anticoagulation is low, compared to what it should be. No more than 50-60% of patients affected by atrial fibrillation (AF) receive anticoagulation. In the setting of AF, VKAs are safe and effective when properly managed, reducing stroke and systemic embolism by more than 60%. VKAs safety and effectiveness are closely related to the quality of anticoagulation (e.g. time in therapeutic range), and anticoagulation clinics offer the best management of anticoagulant therapy. However, a sizeable proportion of patients are managed elsewhere. In clinical practice, in the setting of AF, a low prescription rate of VKAs is frequently observed and this is due also to difficulties in managing laboratory monitoring and drug dose adjustment. The suboptimal management of therapy with VKAs leads to a lesser efficacy than that reported in clinical trials, and to an increase in adverse reactions. VKAs still remain the first and only available therapy for a number of diseases (e.g. valvular atrial fibrillation and mechanical prosthetic heart valves). Now, since approval of the new oral anticoagulants (NOAs), the choice of anticoagulant therapy in definite settings, such as stroke prevention in non-valvular atrial fibrillation (SPAF) or treatment of venous thromboembolism, has surely become more intriguing but also more problematic. In light of these new therapeutic options, we reviewed VKAs therapy, in the setting of atrial fibrillation, focusing on VKAs impact in real life. We analyzed the data about efficacy and safety of warfarin at three levels: clinical trial and real life, outside and inside anticoagulation clinics.
维生素 K 拮抗剂（VKAs）在临床实践中广泛应用，几乎有 1%的总人口一生中至少接受过一次口服抗凝治疗。然而，与应该达到的抗凝治疗率相比，目前的抗凝治疗处方率较低。只有不到 50-60%的房颤（AF）患者接受抗凝治疗。在 AF 患者中，VKAs 经过适当管理是安全有效的，可使卒中与全身性栓塞风险降低 60%以上。VKAs 的安全性和有效性与抗凝质量（例如治疗范围内的时间）密切相关，抗凝门诊为抗凝治疗的最佳管理提供了保障。然而，仍有相当一部分患者在其他地方接受治疗。在临床实践中，经常观察到 AF 患者的 VKAs 处方率较低，这也是由于实验室监测和药物剂量调整管理困难所致。VKAs 治疗管理欠佳会导致疗效不如临床试验报道的那么好，并且不良反应增加。VKAs 仍然是多种疾病（如瓣性房颤和机械人工心脏瓣膜）的首选且唯一可用的治疗方法。现在，随着新型口服抗凝剂（NOAs）的批准，在某些明确情况下（如非瓣膜性房颤的卒中预防[SPAF]或静脉血栓栓塞症的治疗），抗凝治疗方案的选择无疑变得更加复杂，也更具挑战性。鉴于这些新的治疗选择，我们在房颤背景下回顾了 VKAs 治疗，重点关注 VKAs 在现实生活中的影响。我们分析了华法林在临床试验和现实生活、抗凝门诊内外三个层面的疗效和安全性数据。
