Masjuán Jaime, Álvarez-Sabín José, Blanco Miguel, de Felipe Alicia, Gil-Núñez Antonio, Gállego-Culleré Jaime, Vivancos José
Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana.
Rev Neurol. 2014 Jul 1;59(1):25-36.
Atrial fibrillation is the most frequent arrhythmia seen in clinical practice and is one of the most important risk factors for suffering a stroke. Strokes associated to atrial fibrillation are more severe, present higher mortality and disability rates, and there is a greater risk of recurrence. Consequently, both primary and secondary prevention of stroke associated to atrial fibrillation by means of suitable antithrombotic treatment is clearly essential in order to lower this risk. Chronic oral anticoagulants are the cornerstone of antithrombotic treatment in patients with non-valvular atrial fibrillation, especially in those who have already had a stroke. Vitamin K antagonists have traditionally been used for this purpose. Yet, these drugs have several important disadvantages (narrow therapeutic window, unpredictable response, numerous interactions with drugs and foods, as well as starting and finishing their action slowly), which limit their use in clinical practice. The new oral anticoagulants not only overcome these disadvantages but also have proved to be at least as effective as warfarin in the prevention of strokes and systemic embolism in patients with non-valvular atrial fibrillation. Additionally, they have been shown to have a better safety profile, especially with an important drop in the risk of intracranial haemorrhage, regardless of the antecedents of stroke or transient ischaemic attack, which makes them first-choice drugs in the treatment of these patients.
心房颤动是临床实践中最常见的心律失常，也是发生中风的最重要危险因素之一。与心房颤动相关的中风更为严重，死亡率和致残率更高，复发风险也更大。因此，通过适当的抗血栓治疗对与心房颤动相关的中风进行一级和二级预防，显然对于降低这种风险至关重要。慢性口服抗凝剂是非瓣膜性心房颤动患者抗血栓治疗的基石，尤其是对于那些已经发生过中风的患者。传统上一直使用维生素K拮抗剂来达到这一目的。然而，这些药物有几个重要缺点（治疗窗窄、反应不可预测、与药物和食物有众多相互作用，以及起效和失效缓慢），这限制了它们在临床实践中的应用。新型口服抗凝剂不仅克服了这些缺点，而且已被证明在预防非瓣膜性心房颤动患者的中风和全身性栓塞方面至少与华法林一样有效。此外，无论患者有无中风或短暂性脑缺血发作史，新型口服抗凝剂都显示出更好的安全性，尤其是颅内出血风险显著降低，这使其成为这些患者治疗的首选药物。
