Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research.
Stroke Prevention in Atrial Fibrillation: Our Current Failures and Required Research.
复制标题
房颤中的中风预防：我们当前的失败和所需的研究。
DOI：
10.1161/strokeaha.123.040447
复制
发表时间：
2024
期刊：
影响因子：
8.3
通讯作者：
Hsu,JonathanC
中科院分区：
文献类型：
--
作者：
Gurol,MEdip;Wright,ClintonB;Janis,Scott;Smith,EricE;Gokcal,Elif;Reddy,VivekY;Merino,JoséG;Hsu,JonathanC
非瓣膜性心房颤动是中老年人常见的心律失常，可引起缺血性卒中和全身性栓塞。终生使用口服抗凝剂可降低这些缺血性事件的风险，但会增加重大和临床相关血管病变的风险。这些药物还需要严格的疗效依从性，并且在高风险患者中的失败率也不低。左心耳封堵术是一种预防房颤患者缺血性卒中的非药物方法，无需终身使用抗凝剂，但该手术可能发生并发症和残留栓塞事件。这次卒中预防学术界和工业界圆桌会议的研讨会讨论了进一步降低房颤患者缺血和出血风险所需的未来研究。直接凝血酶抑制剂、因子Xa抑制剂和左心耳封堵术是FDA批准的方法，而因子XIa抑制剂目前正在3期随机对照试验中研究，用于预防卒中。这些治疗的益处、风险和缺点以及未来在不同高危患者人群中所需的研究在本共识声明中进行了综述。
Nonvalvular atrial fibrillation is a common rhythm disorder of middle-aged to older adults that can cause ischemic strokes and systemic embolism. Lifelong use of oral anticoagulants reduces the risk of these ischemic events but increases the risk of major and clinically relevant hemorrhages. These medications also require strict compliance for efficacy, and they have nontrivial failure rates in higher-risk patients. Left atrial appendage closure is a nonpharmacological method to prevent ischemic strokes in atrial fibrillation without the need for lifelong anticoagulant use, but this procedure has the potential for complications and residual embolic events. This workshop of the Roundtable of Academia and Industry for Stroke Prevention discussed future research needed to further decrease the ischemic and hemorrhagic risks among patients with atrial fibrillation. A direct thrombin inhibitor, factor Xa inhibitors, and left atrial appendage closure are FDA-approved approaches whereas factor XIa inhibitors are currently being studied in phase 3 randomized controlled trials for stroke prevention. The benefits, risks, and shortcomings of these treatments and future research required in different high-risk patient populations are reviewed in this consensus statement.