Brown Louise A E, Boos Christopher J
Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK.
Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK; Dept of Postgraduate Medical Education, Bournemouth University, UK.
Int J Cardiol. 2017 Jan 15;227:863-868. doi: 10.1016/j.ijcard.2016.09.086. Epub 2016 Sep 30.
Atrial fibrillation (AF) and heart failure (HF) frequently coexist. AF is identified in approximately one third of patients with HF and is linked to increased morbidity and mortality than from either condition alone. AF is relatively more common in HF with preserved ejection fraction (HFpEF) than with reduced ejection fraction (HFrEF). Nevertheless, the risk of stroke and systemic embolism (SSE) is significantly increased with both HF types and the absolute risk is heavily influenced by the presence and severity of associated additional stroke risk factors. The European Society of Cardiology has very recently introduced a third HF subtype entitled HF with mid-range ejection fraction (HFmrEF). At present oral anticoagulation is recommended for all patients with AF and HF, independent of HF type. In addition to warfarin there are currently four non-vitamin K oral anticoagulants (NOACs, previously called novel oral anticoagulants) that have been approved for the prevention of SSE. They consist of one direct thrombin inhibitor, dabigatran and three factor Xa inhibitors: rivaroxaban, apixaban and, most recently, edoxaban. In this review article we present an overview of the evidence to support the use of NOACs for the prevention of SSE in patients with AF and HF and review the influence of HF subtype and co-morbidities on the potential choice of oral anticoagulant.
心房颤动（AF）与心力衰竭（HF）常并存。在约三分之一的HF患者中可发现AF，且与单独任何一种疾病相比，其与发病率和死亡率增加相关。AF在射血分数保留的心力衰竭（HFpEF）中比在射血分数降低的心力衰竭（HFrEF）中相对更常见。然而，两种类型的HF发生卒中及全身性栓塞（SSE）的风险均显著增加，且绝对风险受相关其他卒中危险因素的存在及严重程度的严重影响。欧洲心脏病学会最近引入了第三种HF亚型，即射血分数中等范围的心力衰竭（HFmrEF）。目前，推荐对所有AF合并HF患者进行口服抗凝治疗，与HF类型无关。除华法林外，目前有四种非维生素K口服抗凝药（NOACs，以前称为新型口服抗凝药）已被批准用于预防SSE。它们包括一种直接凝血酶抑制剂达比加群和三种Xa因子抑制剂：利伐沙班、阿哌沙班，以及最近的依度沙班。在这篇综述文章中，我们概述了支持使用NOACs预防AF合并HF患者发生SSE的证据，并综述了HF亚型及合并症对口服抗凝药潜在选择的影响。
