新型抗凝药在房颤性卒中防治中应用的研究进展

Research progress on the application of novel anticoagulants in the preve ntion and treatment of atrial fibrillation stroke

房颤性卒中的发生是房颤致残、致死的主要原因,也是导致房颤患者预后不良的重要因素,进行有效的抗凝治疗是改善患者预后的关键。既往临床上常用的口服抗凝药以华法林为主,其可同时干扰凝血机制的诸多靶点,但存在起效慢、需通过检测凝血功能调整用药等弊端。近年来,直接凝血酶抑制剂(达比加群酯)和Ⅹa因子抑制剂(利伐沙班、阿哌沙班、依度沙班)的临床应用优势逐渐获得了认可。研究表明,上述药物可有效降低房颤患者发生卒中、血栓形成的风险。但是,由于上述新型抗凝药的临床应用时间较短,如何明确适应证、规范剂量及范围、获益/风险比等实际问题均需要更多的临床研究加以分析。本文针对相关新型抗凝药的作用机制和临床研究进展进行简要综述,希望为其规范使用提供参考。

Stroke in atrial fibrillation is the main cause of disability and death in patients with atrial fibrillation,and also an important factor leading to poor prognosis in patients with atrial fibrillation.Effective anticoagulation therapy is the key to improve patient prognosis.Warfarin is the main oral anticoagulant commonly used in clinical practice,which can interfere with many targets of the coagulation mechanism at the same time,but it has disadvantages such as slow onset of effect and need to adjust medication by detecting coagulation function.In recent years,the clinical advantages of direct thrombin inhibitors(Dabigatrun ester)and factorⅩa inhibitors(rivaroxaban,Apixaban,Edoxaban)have been gradually recognized.Studies have shown that these drugs can effectively reduce the risk of stroke and thrombosis in patients with atrial fibrillation.However,due to the short clinical application time of these new anticoagulants,more clinical studies are needed to analyze the practical problems such as how to clarify the indication,regulate the dosage and scope,and benefit/risk ratio.In this paper,the mechanism of action and clinical research progress of related new anticoagulants are briefly reviewed,hoping to provide referenc e for their standardized use.