Atrial fibrillation (AF) increases a patient's stroke risk four- to five-fold. Anticoagulation with the vitamin K antagonist (VKA) warfarin reduces the risk of stroke by 67%, but warfarin carries a significant risk of major bleeding and has unpredictable pharmacodynamics with a narrow therapeutic window, necessitating frequent monitoring of its anticoagulant effect. The non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban provide more predictable anticoagulant activity than warfarin with a lower risk of major bleeding, and each is noninferior to warfarin for the prevention of stroke. All have earned regulatory approval in the past eight years. At least one of the NOACs is approved for use in all patients with AF, except those with mechanical valves and rheumatic mitral valve disease, for whom warfarin remains the only option. Recent clinical trials have shown that antithrombotic regimens including NOACs are safe and effective in patients with AF who need potent antiplatelet therapy.

中文翻译：

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非维生素K拮抗剂口服抗凝剂在房颤治疗中的应用。

心房颤动（AF）将患者的中风风险增加四到五倍。维生素K拮抗剂（VKA）华法林抗凝可将中风的风险降低67％，但华法林具有重大出血的重大风险，并且药效学具有不可预测性，且治疗范围狭窄，因此必须经常监测其抗凝作用。非维生素K拮抗剂口服抗凝剂（NOAC）达比加群，利伐沙班，阿pixaban和edoxaban比华法林具有更可预测的抗凝活性，且发生大出血的风险较低，并且在预防中风方面均不亚于华法林。在过去的八年中，所有人都获得了监管部门的批准。除患有机械瓣膜和风湿性二尖瓣疾病的房颤患者外，至少有一种NOAC被批准用于所有房颤患者，对于他们而言，华法林仍然是唯一的选择。最近的临床试验表明，对于需要有效抗血小板治疗的房颤患者，包括NOAC在内的抗血栓形成方案是安全有效的。