Rao Sudipta, Aggarwal Shailesh, Mani Sweatha, Balasubramanian Abirami, Veluswami Keerthana
Internal Medicine, JSS Medical College, Mysore, IND.
Internal Medicine, K.A.P. Viswanatham Government Medical College, Tiruchirappalli, IND.
Cureus. 2024 Jul 2;16(7):e63675. doi: 10.7759/cureus.63675. eCollection 2024 Jul.
Atrial fibrillation (AF) is a predominant contributor to morbidity and mortality, and stroke prevention remains the mainstay for the management of AF. The precise mechanism involved in thrombus formation remains unknown. However, factors such as stretch-induced fibrosis, endothelial dysfunction, disordered atrial contractions, and pro-thrombotic states have been postulated for the development of AF. Various risk assessment strategies have been acknowledged for determining the risk of stroke in AF, of which the congestive heart failure, hypertension, age ≥75, diabetes, stroke, vascular disease, age between 65-74, and female sex (CHA2DS2-VASc) score remains the ultimate risk stratification tool. For the longest time, vitamin K antagonists (VKA) were the only oral anticoagulants available but were associated with an increased risk of bleeding. Recently, direct oral anticoagulants (DOACs) were approved and considered more efficient and safer than or as secure as warfarin in stroke prevention and lowering intra-cranial bleeding events. The pharmacodynamics and pharmacokinetics of DOACs were also clarified in this article. This review article compiles current evidence-based data on the role of DOACs, uncovering their underlying mechanisms, and comparing their efficacy with warfarin in stroke prevention in AF.
心房颤动（AF）是导致发病和死亡的主要因素，预防中风仍然是房颤管理的主要内容。血栓形成的确切机制尚不清楚。然而，诸如拉伸诱导的纤维化、内皮功能障碍、心房收缩紊乱和血栓前状态等因素已被假定与房颤的发生有关。各种风险评估策略已被认可用于确定房颤患者的中风风险，其中充血性心力衰竭、高血压、年龄≥75岁、糖尿病、中风、血管疾病、年龄在65 - 74岁之间以及女性（CHA2DS2-VASc）评分仍然是最终的风险分层工具。在很长一段时间里，维生素K拮抗剂（VKA）是唯一可用的口服抗凝剂，但与出血风险增加有关。最近，直接口服抗凝剂（DOACs）被批准使用，并且在预防中风和降低颅内出血事件方面被认为比华法林更有效、更安全或与华法林一样安全。本文还阐述了DOACs的药效学和药代动力学。这篇综述文章汇编了关于DOACs作用的当前循证数据，揭示其潜在机制，并将其在房颤中风预防方面的疗效与华法林进行比较。
