Pavlova T V, Dupliakov D V, Kuzina T N
Angiol Sosud Khir. 2014;20(1):16-20.
Warfarin has for a long time been considered the "gold standard" of oral anticoagulant therapy. Positive effects of this agent are unambiguously supported by accumulated evidence-based data convincingly confirming a decrease in the risk for thrombolytic complications in patients with many diseases of the cardiovascular system: atrial fibrillation, thrombosis of deep veins of extremities, pulmonary artery thromboembolism. However, warfarin has a series of disadvantages complicating its practical application: the necessity of individual adjustment of the dose to maintain the International Normalized Ratio (INR) within the limits of the target values, clinically significant interactions with other drugs and foodstuffs. In this connection, the advent of new oral anticoagulants such as dabigatran, rivaroxaban, and apixaban is associated with great hopes concerning increased efficiency and safety of anticoagulant therapy. However, while the results of large-scale clinical trials are promising, the data on using these agents in real clinical practice suggest that prescription and administration of new oral anticoagulants should be approached with great caution, thoroughly weighing potential risks and benefits. Therefore, switching over the patients with the already adjusted dosage of warfarin and stable values of the INR to new drugs seems hardly advisable.
长期以来，华法林一直被视为口服抗凝治疗的“金标准”。大量基于证据的数据明确支持了这种药物的积极作用，令人信服地证实了它可降低患有多种心血管系统疾病（如心房颤动、四肢深静脉血栓形成、肺动脉血栓栓塞）的患者发生溶栓并发症的风险。然而，华法林存在一系列缺点，使其实际应用变得复杂：需要根据个体情况调整剂量，以将国际标准化比值（INR）维持在目标值范围内，与其他药物和食物存在具有临床意义的相互作用。就此而言，新型口服抗凝药（如达比加群、利伐沙班和阿哌沙班）的出现，让人们对提高抗凝治疗的有效性和安全性寄予厚望。然而，尽管大规模临床试验的结果很有前景，但在实际临床实践中使用这些药物的数据表明，在处方和使用新型口服抗凝药时应格外谨慎，要充分权衡潜在的风险和益处。因此，将已经调整好华法林剂量且INR值稳定的患者换成新药似乎并不可取。
