Mizoguchi Tadataka, Yasaka Masahiro
Nihon Rinsho. 2016 Apr;74(4):627-33.
Non-valvular atrial fibrillation (NVAF) is the most common cardiac source of emboli in cardioembolic stroke which occupies from 1/4 to 1/3 of acute brain infarction in Japan. Non-vitamin K antagonist oral anticoagulants (NOAC) have been used widely because they are easy to use, their effect in preventing ischemic stroke is higher than or as high as warfarin, their incidence of major hemorrhage is lower than or as low as warfarin, and their incidence of intracranial hemorrhage is much lower than warfarin. However, there seem several issues to address regarding NOAC treatment, such as reversal of anticoagulation, antidotes, monitoring of anticoagulation, rt-PA treatment for acute stroke patients treated with NOACs. In this review, current strategies and issues of anticoagulation for prevention of stroke in NVAF are discussed.
非瓣膜性心房颤动（NVAF）是心源性卒中最常见的心脏栓子来源，在日本占急性脑梗死的1/4至1/3。非维生素K拮抗剂口服抗凝药（NOAC）已被广泛使用，因为它们使用方便，预防缺血性卒中的效果高于或等同于华法林，大出血发生率低于或等同于华法林，且颅内出血发生率远低于华法林。然而，关于NOAC治疗似乎有几个问题需要解决，如抗凝的逆转、解毒剂、抗凝监测、接受NOAC治疗的急性卒中患者的rt-PA治疗。在本综述中，讨论了NVAF中预防卒中的当前抗凝策略和问题。
