Laäs D J, Naidoo M
Discipline of Family Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
S Afr Med J. 2018 Jul 25;108(8):640-646. doi: 10.7196/SAMJ.2018.v108i8.13309.
This review evaluates the current literature on available oral anticoagulants and atrial fibrillation with specific relevance to the South African (SA) public healthcare sector, focusing on the pharmacology and monitoring of anticoagulants, current guidelines, initiation of treatment and risk stratification, effectiveness of treatment, cost-effectiveness and specific costing implications. The direct-acting oral anticoagulants (DOACs) are superior to warfarin, with dabigatran being the preferred treatment option in patients with non-valvular atrial fibrillation (NVAF). Warfarin is still the preferred anticoagulant in patients with renal failure and prosthetic heart valves and is still the most cost-effective anticoagulant in the SA public sector setting. There is a growing body of evidence that demonstrates the advantages of DOACs over warfarin in NVAF. Warfarin will remain the anticoagulant of choice until cheaper generic DOACs become available.
本综述评估了当前关于现有口服抗凝剂与心房颤动的文献，特别关注南非公共医疗部门的情况，重点在于抗凝剂的药理学和监测、现行指南、治疗的启动和风险分层、治疗效果、成本效益以及具体的成本影响。直接作用口服抗凝剂（DOACs）优于华法林，达比加群是无瓣膜性心房颤动（NVAF）患者的首选治疗选择。华法林仍是肾衰竭和人工心脏瓣膜患者的首选抗凝剂，并且在南非公共部门环境中仍然是最具成本效益的抗凝剂。越来越多的证据表明，在NVAF中DOACs比华法林更具优势。在更便宜的DOACs仿制药上市之前，华法林仍将是首选的抗凝剂。
