Chu G, Seelig J, Trinks-Roerdink E M, Geersing G J, Rutten F H, de Groot J R, Huisman M V, Hemels M E W
Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Cardiology, Rijnstate, Arnhem, The Netherlands.
Neth Heart J. 2020 Aug;28(Suppl 1):19-24. doi: 10.1007/s12471-020-01446-6.
In recent years, as more and more experience has been gained with prescribing direct oral anticoagulants (DOACs), new research initiatives have emerged in the Netherlands to improve the safety and appropriateness of DOAC treatment for stroke prevention in patients with atrial fibrillation (AF). These initiatives address several contemporary unresolved issues, such as inappropriate dosing, non-adherence and the long-term management of DOAC treatment. Dutch initiatives have also contributed to the development and improvement of risk prediction models. Although fewer bleeding complications (notably intracranial bleeding) are in general seen with DOACs in comparison with vitamin K antagonists, to successfully identify patients with high bleeding risk and to tailor anticoagulant treatment accordingly to mitigate this increased bleeding risk, is one of the research aims of recent and future years. This review highlights contributions from the Netherlands that aim to address these unresolved issues regarding the anticoagulant management in AF in daily practice, and provides a narrative overview of contemporary stroke and bleeding risk assessment strategies.
近年来，随着在开具直接口服抗凝剂（DOACs）方面积累了越来越多的经验，荷兰出现了新的研究举措，以提高DOAC治疗在心房颤动（AF）患者预防中风方面的安全性和合理性。这些举措解决了几个当代未解决的问题，如剂量不当、不依从以及DOAC治疗的长期管理。荷兰的举措也推动了风险预测模型的开发和改进。尽管与维生素K拮抗剂相比，DOACs一般较少出现出血并发症（尤其是颅内出血），但成功识别出血风险高的患者并相应调整抗凝治疗以降低这种增加的出血风险，是近年来和未来几年的研究目标之一。本综述重点介绍了荷兰为解决日常实践中AF抗凝管理方面这些未解决问题所做出的贡献，并对当代中风和出血风险评估策略进行了叙述性概述。
