Bilora Franca, Adamo Angelo, Pomerri Fabio, Prandoni Paolo
Internal Medicine Clinic, Coagulopathy Section, Department of Cardiovascular and Thoracic Sciences, Padua University, Padua, Italy -
Minerva Cardioangiol. 2016 Aug;64(4):494-6.
Rivaroxaban is an oral anticoagulant that acts as a direct, competitive factor Xa inhibitor. Large randomized clinical trials have shown that, at a daily dose of 20 mg, Rivaroxaban is at least as effective as dose-adjusted warfarin for the prevention of stroke or other embolic complications in patients with nonvalvular atrial fibrillation (AF). The safety and efficacy of combining Rivaroxaban with an antiplatelet agent for secondary stroke prevention has not been established. We report the case of an elderly patient with permanent AF and coronary heart disease, who had already suffered an ischemic stroke while on warfarin treatment, and was consequently switched to treatment with an association of Rivaroxaban and Aspirin. Her CHA2DS2-VASc score was 9. The patient developed a severe recurrent disabling ischemic stroke. This case goes to show that the novel direct anticoagulants may fail to prevent recurrent stroke in patients at particularly high risk, even when associated with antiplatelet drugs.
利伐沙班是一种口服抗凝剂，作为一种直接的、竞争性的Xa因子抑制剂。大型随机临床试验表明，对于非瓣膜性心房颤动（AF）患者预防中风或其他栓塞并发症，利伐沙班每日剂量20mg时至少与剂量调整的华法林效果相当。利伐沙班与抗血小板药物联合用于二级预防中风的安全性和有效性尚未确立。我们报告一例患有永久性AF和冠心病的老年患者，该患者在接受华法林治疗时已发生缺血性中风，因此改用利伐沙班和阿司匹林联合治疗。她的CHA2DS2-VASc评分为9分。该患者发生了严重的复发性致残性缺血性中风。该病例表明，即使与抗血小板药物联合使用，新型直接抗凝剂在特别高危的患者中可能无法预防复发性中风。
