Antithrombotic therapy in nonvalvular atrial fibrillation: A narrative review

作者：Sa Susana P D; Rodrigues Rui P; Santos Antunes Joao; Goncalves Francisco Rocha; Nunes Jose Pedro L^*

来源：Revista Portuguesa de Cardiologia, 2011, 30(12): 905-924.

DOI：10.1016/j.repc.2011.09.014

• Atrial fibrillation
• Warfarin
• Aspirin
• Dabigatran
• Rivaroxaban
• Apixaban

Atrial fibrillation (AF) is an important and potentially modifiable cause of stroke. It has been known since 1989 that oral anticoagulant drugs, such as warfarin, lead to a dramatic decrease in stroke associated with AF. The best risk-benefit ratio is obtained with intensity of oral anticoagulant treatment for an INR of 2-3, even in the elderly. Given the risks of anticoagulant therapy, including bleeding, individual thromboembolic risk must be assessed in patients with AF. In 2009, dabigatran was shown to be a reasonable alternative to vitamin K antagonists, establishing itself as a major alternative to warfarin in AF patients. Rivaroxaban and apixaban have subsequently also been shown to be alternatives to warfarin. When there are contraindications to vitamin K antagonists, antiplatelet agents can produce a therapeutic effect, although much less than oral anticoagulants. Apixaban may be a better alternative to aspirin in this setting. Patients with low-risk atrial fibrillation (no risk factors) have not been the subjects of specific clinical trials. It is unclear what would be the best therapeutic choice for these patients.

• 出版日期2011-12