Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.
Hamostaseologie. 2021 Feb;41(1):31-34. doi: 10.1055/a-1329-2523. Epub 2021 Feb 15.
Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and ischemic stroke. The main advantage of DOAC over VKA is the lower rate of bleeding and mortality. This review covers challenges clinicians can encounter when treating patients with AF and ischemic stroke, including timing of DOAC start and ongoing randomized clinical trials, appropriate dosing, and available comparative evidence across DOACs. For patients without AF but with an ischemic stroke, the review outlines the role of DOACs. Finally, the risk of thrombotic events associated with specific DOAC reversal agents and DOAC pausing is reviewed.
直接口服抗凝剂（DOAC）在房颤（AF）和缺血性卒中患者中优于维生素 K 拮抗剂（VKA）。DOAC 优于 VKA 的主要优势在于出血和死亡率较低。本综述涵盖了临床医生在治疗 AF 和缺血性卒中患者时可能遇到的挑战，包括 DOAC 起始时间和正在进行的随机临床试验、适当的剂量以及 DOAC 之间的可用比较证据。对于没有 AF 但有缺血性卒中的患者，综述概述了 DOAC 的作用。最后，还回顾了与特定 DOAC 逆转剂和 DOAC 暂停相关的血栓形成事件风险。
