新型口服抗凝药(NOAC)在急性冠状动脉综合征中的应用进展

Developments of Novel Oral Anticoagulants in Acute Coronary Syndrome

急性冠状动脉综合征(ACS)是临床常见急症,尽管采用双联抗血小板药物,ACS后患者仍有较高的缺血事件复发率。凝血酶在ACS后血栓形成中具有重要作用。既往研究曾表明,华法林与阿司匹林联用可显著降低ACS患者死亡率,但因出血风险较高未获广泛临床应用。新型口服抗凝药(NOAC)具有起效快、更安全、服用更方便的优点,近年来针对其进行了大量研究。结果显示,利伐沙班2.5mg每日两次可显著减少ACS后患者缺血复发的风险,带来临床净获益。

Acute coronary syndrome（ACS） is a clinical emergency, with high ischemic recurrent rate despite of the widely use of double antiplatelet therapy such as aspirin and P2Y12 inhibitor. Thrombin plays an important role in formation of thrombus after an ACS event. Although the studies adding warfarin to single or DAPT provide proof-of-principle that attenuation of thrombin generation is of benefit, the complexity of warfarin management and the increased risk of bleeding has restricted its use in this setting. Since NOACs are quicker and safer and easier to be taken than warfarin, lots of trials have completed about them. And only rivaroxaban 2.5mg twice daily shows effectiveness in reduction of the ischemic recurrent risk in patients of ACS.