Lau Yee C, Lip Gregory Y H
University of Birmingham Centre for Cardiovascular Sciences, City Hospital , Birmingham , UK.
Expert Opin Pharmacother. 2014 Oct;15(15):2193-204. doi: 10.1517/14656566.2014.948418. Epub 2014 Aug 12.
Atrial fibrillation (AF) is the most common arrhythmia and brings about significant mortality and morbidity as a result of heart failure and ischemic stroke. Besides vitamin K antagonists (VKA), several new pharmacological agents (nonvitamin K antagonist oral anticoagulants [NOACs]) and procedures have since been developed to improve stroke prevention efforts in AF.
This paper will discuss the antiplatelet agents, VKA and NOACs, and their efficacy and safety for stroke prevention in AF. Focus will be placed on the NOACs, their limitations and special considerations. A short assessment of other nonpharmacological antithrombotic procedures will also be made. An extensive PubMed search was used to identify suitable papers.
Despite the advent of NOACs, the VKAs will remain as an important oral anticoagulant due to its versatility. However, convenience and limited food or drug interactions will make NOACs attractive options. The choice between various NOACs will depend on several important factors as illustrated below. Over time, the role for antiplatelet agents will gradually diminish. Left atrial appendage occlusion devices have shown promising results and may have the potential to change the way clinicians manage thromboembolism risks related to AF.
心房颤动（AF）是最常见的心律失常，由于心力衰竭和缺血性中风，会导致显著的死亡率和发病率。除了维生素K拮抗剂（VKA）外，此后还开发了几种新型药物（非维生素K拮抗剂口服抗凝剂[NOACs]）和治疗方法，以加强房颤患者的中风预防。
本文将讨论抗血小板药物、VKA和NOACs，以及它们在预防房颤中风方面的疗效和安全性。重点将放在NOACs、它们的局限性和特殊注意事项上。还将对其他非药物抗血栓治疗方法进行简要评估。通过广泛的PubMed检索来确定合适的论文。
尽管出现了NOACs，但由于其多功能性，VKA仍将是一种重要的口服抗凝剂。然而，便利性以及有限的食物或药物相互作用将使NOACs成为有吸引力的选择。如下所述，各种NOACs之间的选择将取决于几个重要因素。随着时间的推移，抗血小板药物的作用将逐渐减弱。左心耳封堵装置已显示出有前景的结果，可能有潜力改变临床医生管理与房颤相关的血栓栓塞风险的方式。
