非瓣膜性心房颤动口服抗凝药物临床应用研究进展

Progress in the Clinical Application of Oral Anticoagulants in Nonvalvular Atrial Fibrillation

心房颤动(atrial fibrillation, AF)是最常见的心律失常之一,与不良事件尤其是缺血性卒中显著相关。非瓣膜性心房颤动(nonvalvular atrial fibrillation, NVAF)是AF中最常见的类型。随着年龄的增加,AF患病率也逐渐增加。口服抗凝药物治疗(oral anticoagulant therapy, OAT)是NVAF高危患者缺血性卒中预防的基石。目前,指南推荐将直接口服抗凝药(direct oral anticoagulants, DOACs)优先于维生素K拮抗剂(vitamin K antagonists, VKAs)用于NVAF治疗。然而,口服抗凝药(oral anticoagulant, OAC)的应用存在消化道出血和致命颅内出血的风险。由于这些潜在的风险影响,进而导致预防策略的实施不足。鉴于NVAF患者OAC选择面临的挑战,本文结合近年来国内外有关NVAF患者应用OAC的文献证据,对OAC在治疗NVAF患者中的研究进行归纳整理和分析,以期为NVAF患者OAC临床应用提供最新证据。

Atrial fibrillation (AF) is one of the most common arrhythmias and is significantly associated with adverse events, especially ischemic stroke. Nonvalvular atrial fibrillation (NVAF) is the most com-mon type of AF. The prevalence of AF increases progressively with age. Oral anticoagulant therapy (OAT) is the cornerstone of ischemic stroke prevention in patients at risk for NVAF. Currently, guidelines recommend direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) for the treatment of NVAF. However, the use of oral anticoagulant (OAC) carries the risk of gastrointestinal bleeding and fatal intracranial hemorrhage. Due to the impact of these potential risks, this in turn leads to inadequate implementation of preventive strategies. In view of the challenges of OAC selec-tion in patients with NVAF, this article summarizes and analyzes the studies of OAC in the treatment of patients with NVAF, taking into account the evidence in the literature about the application of OAC in patients with NVAF in recent years, both at home and abroad, with a view to providing the latest evidence in the clinical application of OAC in patients with NVAF.