新型口服抗凝药在非瓣膜性房颤治疗中的应用

Clinical application of novel oral anticoagulants in the patients with nonvalvular atrial fibrillation

抗凝治疗是房颤病人卒中预防的关键。华法林是预防卒中的经典抗凝药,推荐用于有卒中或短暂性脑缺血史的高危房颤病人。由于其起效慢、治疗剂量范围窄、药物食物相互作用多、需常规监测凝血和调整剂量,限制了其在临床的广泛应用。因此,新型口服抗凝药(new oral anticoagulants,NOACs)达比加群、利伐沙班、阿哌沙班、依度沙班凭借其剂量固定、无需常规监测凝血、药物食物相互作用少、颅内出血并发症少等优势脱颖而出,引起广泛重视。本文拟从药理学、临床研究及临床应用现状等角度阐述上述NOACs对非瓣膜性房颤的价值及意义。

Anticoagulant therapy is the key to the prevention of stroke in patients with atrial fibrillation （AF）. Warfarin is a classical oral anticoagulant for the prevention of stroke and is recommended for AF patients with high stroke risks （prior stroke or transient ischemic attack）. Due to slow onset, narrow therapeutic dosage range and frequent food and drug interac- tions, regular coagulation monitoring and dose adjustment are required. For this reason, its widespread use is limited clinically. With the advantages of fixed dose without routine coagulation monitoring,less food and drug interactions,and fewer intracranial bleeding complications, novel oral anticoagulants（ NOACs）, such as dabigatran, rivaroxaban, apixaban and edoxaban emerged prominently and received clinical attention to a great extent. This review intends to explain the value and significance of NOACs in the treatment of patients with nonvalvular AF from the perspectives of pharmacology, clinical research and application.