新型口服抗凝血劑在亞洲缺血性腦中風病患之運用

Novel Oral Anticoagulants for Ischemic Stroke in Asia

陳彥銘(Yen-Ming Chen) ； 邱浩彰(Hou-Chang Chiu)

《台灣醫學》 23卷6期 (2019/11) Pp. 733-738

https://doi.org/10.6320/FJM.201911_23(6).0006

摘要

腦中風與心房顫動息息相關，而中風所帶來的風險也隨著亞洲的老化人口增加。在新型口服抗凝血劑問市前，warfarin已被證實可有效下降心房顫動導致的中風風險。然而，亞洲族群的獨特性使得warfarin的服藥遵從性偏低。新型口服抗凝血劑在四大研究中己被證實，對於非瓣膜性心房顫動患者是個比warfarin更好的選擇。然而，亞洲族群在標準劑量及低劑量的選擇上需要更多研究作為治療佐證，不建議常規選擇低劑量使用來預防中風。

關鍵字

新型口服抗凝血劑 ； 心房顫動

並列摘要

There is a close relationship between stroke and atrial fibrillation. The risk of stroke is increasing with the aging population in Asia. Warfarin had been proved to reduce the risk of cardioembolic stroke before novel oral anticoagulants (NOACs) launched. However, the drug compliance was poor because of the uniqueness of Asian ethnic groups. NOACs had been proved to be a better choice for patients of nonvalvular atrial fibrillation in the four studies included RE-LY trial, ROCKET AF trial, ENGAGE AF trial, and ARISTOTLE trial. However, we need more clinical trials to guide the treatment strategy between the choices of standard and low dosage in Asian population, and we did not recommend an unjustified underdosing.

並列關鍵字

novel oral anticoagulants (NOACs) ； atrial fibrillation

參考文獻

Go AS, Hylek EM, Phillips KA, et al: Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-5.

Lip GYH, Brechin CM, Lane DA: The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest 2012;142:1489-98.

Tse HF, Wang YJ, Ahmed Ai-Abdullah M, et al: Stroke prevention in atrial fibrillation--an Asian stroke perspective. Heart Rhythm 2013;10:1082-8.

Lee CH, Liu PY, Tsai LM, et al: Characteristics of hospitalized patients with atrial fibrillation in Taiwan: a nationwide observation. Am J Med 2007;120: 819.e1-819.e7.

Ching CE, Wu TJ, Ueng KC, et al: 2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the management of atrial fibrillation. J Formosan Medical Assoc 2016;115:893-952.