PDF(Pubmed)
Abstract：
Atrial fibrillation (AF) is a predominant contributor to morbidity and mortality, and stroke prevention remains the mainstay for the management of AF. The precise mechanism involved in thrombus formation remains unknown. However, factors such as stretch-induced fibrosis, endothelial dysfunction, disordered atrial contractions, and pro-thrombotic states have been postulated for the development of AF. Various risk assessment strategies have been acknowledged for determining the risk of stroke in AF, of which the congestive heart failure, hypertension, age ≥75, diabetes, stroke, vascular disease, age between 65-74, and female sex (CHA2DS2-VASc) score remains the ultimate risk stratification tool. For the longest time, vitamin K antagonists (VKA) were the only oral anticoagulants available but were associated with an increased risk of bleeding. Recently, direct oral anticoagulants (DOACs) were approved and considered more efficient and safer than or as secure as warfarin in stroke prevention and lowering intra-cranial bleeding events. The pharmacodynamics and pharmacokinetics of DOACs were also clarified in this article. This review article compiles current evidence-based data on the role of DOACs, uncovering their underlying mechanisms, and comparing their efficacy with warfarin in stroke prevention in AF.
摘要：
心房颤动(AF)是发病率和死亡率的主要因素。卒中预防仍是房颤管理的主要手段。血栓形成的确切机制尚不清楚。然而,因素，如拉伸诱导的纤维化，内皮功能障碍,心房收缩紊乱,和血栓前状态已被假定为房颤的发展。各种风险评估策略已被确认用于确定房颤患者中风的风险。其中充血性心力衰竭，高血压,年龄≥75，糖尿病，中风,血管疾病,年龄在65~74岁之间,女性(CHA2DS2-VASc)评分仍是最终的危险分层工具.在最长的时间里，维生素K拮抗剂(VKA)是唯一可用的口服抗凝剂,但与出血风险增加相关.最近,直接口服抗凝药(DOAC)在预防卒中和降低颅内出血事件方面获得批准,并被认为比华法林更有效,更安全或更安全.本文还阐明了DOAC的药效学和药代动力学。这篇综述文章汇编了当前关于DOAC作用的循证数据，揭示它们的潜在机制，并比较其与华法林预防房颤卒中的疗效。
