Mani Helen, Lindhoff-Last Edelgard
Johann Wolfgang Goethe-University Hospital Frankfurt/Main, Department of Internal Medicine, Division of Haemostasis, Frankfurt, Germany.
Drug Des Devel Ther. 2014 Jun 17;8:789-98. doi: 10.2147/DDDT.S45644. eCollection 2014.
Atrial fibrillation (AF) continues to be a leading cause of cerebrovascular morbidity and mortality resulting from cardioembolic stroke. Oral anticoagulation therapy has been shown to decrease the incidence of cardioembolic stroke in patients with AF by more than 50%. Appropriate use of anticoagulation with vitamin K antagonists requires precise adherence and monitoring. A number of factors that potentially induce patients' dissatisfaction reduce quality of patient life. New direct oral anticoagulants, such as the direct factor Xa inhibitors rivaroxaban, apixaban, edoxaban, and the thrombin inhibitor dabigatran, were developed to overcome the limitations of the conventional anticoagulant drugs. However, models to optimize the benefit of therapy and to ensure that therapy can be safely continued are missing for the new oral anticoagulants. This review will briefly describe the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban with focus on their use for prevention of embolic events in AF. Moreover, it will discuss the safety, efficacy, cost data, and benefit for patients' quality of life and adherence.
心房颤动（AF）仍然是心源性栓塞性卒中导致脑血管发病和死亡的主要原因。口服抗凝治疗已被证明可使房颤患者的心源性栓塞性卒中发生率降低50%以上。合理使用维生素K拮抗剂进行抗凝需要精确的依从性和监测。一些可能导致患者不满的因素会降低患者的生活质量。新型直接口服抗凝剂，如直接Xa因子抑制剂利伐沙班、阿哌沙班、依度沙班，以及凝血酶抑制剂达比加群，旨在克服传统抗凝药物的局限性。然而，新型口服抗凝剂缺乏优化治疗益处并确保治疗能够安全持续的模式。本综述将简要介绍新型口服抗凝剂达比加群、利伐沙班、阿哌沙班和依度沙班，重点关注它们在预防房颤栓塞事件中的应用。此外，还将讨论其安全性、有效性、成本数据以及对患者生活质量和依从性的益处。
