新型口服抗凝血劑─心房顫動中風預防的新曙光

Novel Oral Anticoagulants: New Aurora for the Prevention of Stroke in Atrial Fibrillation

陳朝欽(Chao-Chin Chen) ； 雷孟桓(Meng-Huan Lei)

《內科學誌》 23卷2期 (2012/04) Pp. 77-97

https://doi.org/10.6314/JIMT.2012.23(2).01

摘要

心房顫動是臨床最常見的心律不整，由於它在全世界的盛行率不斷攀升，使得理想的血栓預防益發重要。雖然warfarin預防心房顫動的血栓栓塞併發症效果顯著，但因為畏懼出血副作用，監測困難，難以維持狹窄的治療範圍導致使用率普遍低落。最新發展的口服抗凝血劑包括直接凝血酶抑制劑dabigatran和直接抑制Xa因子的apixaban、rivaroxaban等，因為沒有warfarin的許多瑕疵，可望能滿足當前治療選擇上的需求。上述三種藥物在非瓣膜性心房顫動中風預防的第三階段臨床試驗都已完成，與warfarin相比這些新型口服抗凝血劑確實有較佳的安全面，且改善了使用的簡便性。本文將回顧這些數據，但在作結論前還需要更多的數據才能確立在心房顫動病人是否可以取代warfarin。

關鍵字

心房顫動 ； 中風預防 ； 華法林 ； RE-LY試驗 ； ROCKET AF試驗 ； ARRESTOTLE試驗

並列摘要

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. The growing prevalence of AF in the world makes optimal thromboprophylaxis of paramount importance. Although warfarin is an effective therapy for the prevention of thromboembolic complications of AF, it is inadequately used because of fear of hemorrhagic adverse effects and the difficulties associated with monitoring and maintenance of a narrow therapeutic range. Emerging oral anticoagulants include direct thrombin antagonists such as dabigatran or factor Xa inhibitors such as rivaroxaban, apixaban are free from many of warfarin's drawback and might potentially address unmet needs in current therapeutic options for prophylaxis in atrial fibrillation. This paper will review data from completed phase III clinical trials of apixaban, dabigatran, and rivaroxaban for the prophylaxis and treatment of stroke in patients with nonvalvular AF. Indeed, novel oral anticoagulants probably have demonstrated better safety profiles and may improve the ease of use compared with warfarin. Additional data are necessary before conclusions can be drawn on the potential for these new anticoagulant drugs to replace warfarin in patients with AF. (J Intern Med Taiwan 2012; 23: 77-97)

並列關鍵字

Atrial fibrillation ； Stroke prevention ； Warfarin ； RE-LY trial ； ROCKET AF trial ； ARRESTOTLE trial