Ha Andrew C T, Verma Atul, Verma Subodh
aPeter Munk Cardiac Centre, University Health Network bDepartment of Medicine, University of Toronto, Toronto cDivision of Cardiology, Southlake Regional Health Centre, Newmarket dLi Ka Shing Knowledge Institute, St Michael's Hospital eDepartment of Surgery, University of Toronto fDivision of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
Curr Opin Cardiol. 2017 Mar;32(2):174-180. doi: 10.1097/HCO.0000000000000365.
The majority of evidence on the safety and efficacy of oral anticoagulation for stroke prevention amongst patients with atrial fibrillation is derived from those without significant valvular heart disease. This article will review current knowledge, areas of uncertainty and controversy, and ongoing research on oral anticoagulation for stroke prevention amongst patients with valvular heart disease.
The rates of stroke, systemic embolism, and major bleeding were similar for patients with and without significant native valvular disease when treated with direct oral anticoagulants (DOACs) or vitamin K antagonists. There are very limited prospective data on the safety and efficacy of DOAC use for patients with bioprosthetic valves or rheumatic mitral stenosis.
Atrial fibrillation patients with concomitant valvulopathies constitute a group with high thromboembolic risk and should be treated with oral anticoagulation. There is good supportive evidence that DOAC is well tolerated and effective in preventing thromboembolism amongst patients with native valvular disease. Further research is underway to better define the risks and benefits of DOAC use among patients with bioprosthetic valves or rheumatic mitral stenosis in preventing thromboembolic events. Until then, vitamin K antagonists remain the oral anticoagulant of choice for these patient subsets.
关于口服抗凝药在心房颤动患者中预防卒中的安全性和有效性的大多数证据来自无严重瓣膜性心脏病的患者。本文将综述目前关于口服抗凝药在瓣膜性心脏病患者中预防卒中的知识、不确定和有争议的领域以及正在进行的研究。
使用直接口服抗凝剂（DOACs）或维生素K拮抗剂治疗时，有严重原发性瓣膜病和无严重原发性瓣膜病的患者的卒中、全身性栓塞和大出血发生率相似。关于DOACs用于生物人工瓣膜或风湿性二尖瓣狭窄患者的安全性和有效性的前瞻性数据非常有限。
合并瓣膜病的心房颤动患者构成血栓栓塞风险高的一组人群，应接受口服抗凝治疗。有充分的支持证据表明，DOAC在原发性瓣膜病患者中耐受性良好且能有效预防血栓栓塞。正在进行进一步研究，以更好地确定DOAC用于生物人工瓣膜或风湿性二尖瓣狭窄患者预防血栓栓塞事件的风险和益处。在此之前，维生素K拮抗剂仍然是这些患者亚组的口服抗凝药首选。
