新型口服抗凝剂与华法林预防心房颤动患者卒中的比较及现状  

Comparison of the new oral anticoagulant drug with warfarin to prevent stroke in patients with atrial fibrillation

作　　者：方堃[1] 程忻[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中国新药杂志》2012年第11期1214-1219,共6页Chinese Journal of New Drugs

摘　　要：心房颤动是目前最常见的心律失常,也是独立的卒中危险因素。这点在老年人和女性人群中尤为明显。本文回顾了关于心房颤动患者卒中的一级和二级预防的重要文献,并分析了近年来该领域的新进展。维生素K拮抗剂华法林在具有卒中较高风险的心房颤动患者中有着举足轻重的作用。但是,华法林因其与众多药物的相互作用、需要常规血液监测和剂量调整等诸多明显缺点,在临床应用中步履维艰。新型直接凝血酶抑制剂和直接Xa因子抑制剂具有不劣于华法林的卒中预防效果和显著减少出血事件的作用。然而,昂贵的价格和尚缺乏逆转解救治疗手段等都是新型口服抗凝剂现阶段的主要问题。在中国,新型抗凝剂预防心房颤动患者卒中的时代是否已经到来依然值得商榷。Atrial fibrillation（AF） is the most common cardiac arrhythmia and an important independent stroke risk factor,especially in the elderly and female.This article provides the reader with an overview as well as an update on primary and secondary stroke prevention strategies in patients with AF.Warfarin,a vitamin K antagonist,remains the cornerstone therapy in AF patients at high risk of stroke.Meanwhile,warfarin has multiple and well-known limitations,including numerous interactions with other drugs,the need for regular blood monitoring and dose adjustments.New direct thrombin inhibitor and direct factor Xa inhibitor are at least as effective as warfarin,and lead to a significant and clinically relevant decrease in bleed profiles.However,they may not be necessary for the individual patient in whom the INR has been well controlled with warfarin for years.In addition,much novel oral anticoagulation is much more expensive than warfarin,and lack of these agents to reverse.After all this time,it is still question whether a new era of anticoagulation appears to be emerging for patients with atrial fibrillation in China.

关 键 词：心房颤动 卒中 抗凝治疗 华法林 凝血酶抑制剂 XA因子抑制剂 

分 类 号：R973.2[医药卫生—药品]