Minardi Simona, Sciarra Luigi, Robles Antonio Gianluca, Scara Antonio, Sciarra Francesco, De Masi De Luca Gabriele, Romano Silvio
Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Cardiology, L. Bonomo Hospital, Andria, Italy.
Front Pharmacol. 2024 May 10;15:1384213. doi: 10.3389/fphar.2024.1384213. eCollection 2024.
Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the "traditional" management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic-pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.
心房颤动（AF）是一种常见的心律失常，会带来显著的中风和血栓栓塞事件风险。抗凝治疗对于预防AF患者的中风至关重要。包括心脏病患者在内，各年龄段越来越多的人将体育活动视为休闲锻炼和竞技运动。因此，有AF风险的患者越来越多地被允许进行体育活动。由于需要平衡药物的风险和益处，同时考虑到在避免使用药物时的出血性（如外伤时）和缺血性并发症，对这些患者进行口服抗凝治疗（OAT）的管理极具挑战性。官方针对这些患者的建议有限，并且在大多数情况下禁止进行会增加外伤风险及随之而来出血风险的运动。这些建议受到OAT“传统”管理方式的强烈影响，后者主要涉及香豆素衍生物。非维生素K拮抗剂直接口服抗凝剂（DOACs）具有比香豆素衍生物更有利的药代动力学-药效学特征，可能为改变AF患者及OAT适应证患者体育活动的管理方法带来契机。本研究旨在回顾AF运动员中抗凝剂的使用情况，突出其疗效和安全性，并提供有关其管理的实际考量。
