心房颤动患者口服新型抗凝药预防卒中的剂量问题

Dose issue of novel oral anticoagulants to prevent stroke in patients with atrial fibrillation

口服抗凝药是心房颤动患者卒中预防的重要药物。与传统口服抗凝药华法林相比，新型口服抗凝药（noveloralanticoagulants，NOACs）具有高效、安全和无需监测凝血功能的特点，但目前的临床报道显示使用NOACs时的剂量多偏小，其主要原因可能与风险规避和医患偏好不同有关。从安全性和有效性方面分析，NOACs剂量偏大时缺血性卒中或系统性栓塞风险较低，而NOACs剂量偏小时出血风险则较低。考虑到不同事件发生率、致残率和病死率之间的差异，心房颤动患者更适合使用偏大剂量。在选择具体剂量时，考虑到不同药物的特异性，应根据指南推荐、适当参考肾功能并结合患者偏好和个体差异，给予合适的剂量、强度和给药方案以取得最佳临床疗效。

Oral anticoagulants are important for preventing stroke in patients with atrial fibrillation. Compared with the traditional oral anticoagulant warfarin, the novel oral anticoagulants （NOACs） have the characteristics of high efficiency, safety, and no need to monitor coagulation function. However, current clinical reports have showed that the dose is usually low when NOACs were used for preventing stroke in patients with atrial fibrillation. Its main reason may be associated with the risk avoidance and the difference in doctor and patient preferences. The analysis from the aspects of safety and effectiveness, the risk of ischemic stroke or systemic embolism is lower when the dose of NOACs is relatively high, and the risk of hemorrhage is lower when the dose of NOACs is relatively lower. Given the differences between the incidences of different events, the disability rate and the mortality rate, the patient with atrial fibrillation are more suitable for using high-dose drug. When choosing a specific dose, taking into account the specificity, the appropriate dose, intensity, and dosing regimen should be given according to the guideline recommendations, aoorooriate reference to renal function and oatient oreferences, and individual differences in order to obtain the best clinical efficacy..