Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
J Stroke. 2016 May;18(2):169-78. doi: 10.5853/jos.2016.00052. Epub 2016 May 10.
After recent randomized control trials (RCTs), non-vitamin K oral anticoagulants (NAOAs) are now widely being used in patients with atrial fibrillation (AF) worldwide. However, current guidelines for the use of NOACs in patients with AF are derived mostly using a Caucasian population and non-stroke patients. Relatively few Asian patients with AF and stroke are included in the recent RCTs. As a result, the optimal use of NOACs in this particular group of patients is remains to be settled. The optimal dose of NOACs and response to current dose of NOACs of Asian patients with AF and stroke may differ from those of westerners and patients without stroke. We reviewed available research on NOACs by searching PubMed and ClinicalTrials.gov published in English up to December 2015. In this review, the characteristics of Asian AF patients with prior stroke/transient ischemic attack, which might influence the efficacy and safety profiles of NOACs, are discussed. In addition, we summarize the risk factors for bleeding complications on NOACs, which are related or unrelated with the blood level of NOACs. Lastly, we provide recent data of reduced dose of NOACs from RCTs or large cohorts. The results reviewed herein call for clinical trials to test whether a reduced dose of NOACs is beneficial in Asian patients with AF and stroke. In the meantime, further researches are needed to establish the safety and efficacy of dose-adjusted NOACs considering both blood levels of NOACs and fragility of patients in Asian patients with AF and stroke.
在最近的随机对照试验（RCT）之后，非维生素 K 口服抗凝剂（NOACs）现在在全球范围内广泛用于房颤（AF）患者。然而，目前关于 AF 患者使用 NOACs 的指南主要是基于白种人群和非中风患者的数据得出的。最近的 RCT 中相对较少包括亚洲 AF 和中风患者。因此，NOACs 在这一特定患者群体中的最佳使用方法仍有待解决。亚洲 AF 和中风患者的 NOAC 最佳剂量以及对当前剂量的反应可能与西方人以及无中风患者不同。我们通过检索 PubMed 和 ClinicalTrials.gov 上截至 2015 年 12 月发表的英文文献，回顾了有关 NOACs 的可用研究。在这篇综述中，讨论了具有中风/短暂性脑缺血发作史的亚洲 AF 患者的特点，这些特点可能影响 NOACs 的疗效和安全性。此外，我们总结了与 NOACs 血药浓度相关或不相关的出血并发症的危险因素。最后，我们提供了来自 RCT 或大样本的最近关于减少 NOACs 剂量的数据。本文综述的结果呼吁进行临床试验，以测试减少 NOACs 剂量是否对亚洲 AF 和中风患者有益。同时，需要进一步研究以确定考虑到亚洲 AF 和中风患者的 NOACs 血药浓度和脆弱性的调整剂量的 NOACs 的安全性和有效性。
