Abstract:

Anticoagulation is considered the cornerstone of ischemic stroke prevention strategies in patients with non-valvular atrial fibrillation. Compared with the traditional oral anticoagulant warfarin, new oral anticoagulants have the advantages of rapid onset of action, short half-life, fewer drug interactions, and no need for frequent monitoring on coagulation parameters, and are commonly used in prophylaxis, substantially reducing the risk of ischemic stroke in patients with non-valvular atrial fibrillation. However, in patients with non-valvular atrial fibrillation who are at increased risk of stroke and bleeding due to combined intracranial atherosclerotic stenosis, acute ischemic stroke, intracranial hemorrhage, and intracranial microhemorrhage, the selection of clinical anticoagulation therapy and the timing of initiation are undoubtedly challenging. This article reviews the use of new oral anticoagulants in patients with non-valvular atrial fibrillation combined with common cerebrovascular diseases, providing clinical references for treatment and prevention.

Key words:

Non-valvular atrial fibrillation, Cerebrovascular disease, Intracranial hemorrhage, Stroke recurrence, New oral anticoagulants

摘要：

抗凝治疗被认为是非瓣膜性心房颤动（房颤）患者缺血性卒中预防策略的基石。新型口服抗凝药相较于传统口服抗凝药华法林，具有起效快、半衰期短、药物相互作用少以及无需频繁监测凝血指标等优点，被普遍应用于预防治疗中，大幅降低了非瓣膜性房颤患者缺血性卒中的发生风险。但对于合并颅内动脉粥样硬化狭窄、急性缺血性卒中、颅内出血、颅内微出血等增加卒中及出血风险的非瓣膜性房颤患者，临床抗凝治疗及启动时间的选择无疑是个挑战。本文将对新型口服抗凝药在合并常见脑血管病的非瓣膜性房颤患者中的应用进行综述，为临床治疗与预防提供参考。

关键词:

非瓣膜性心房颤动, 脑血管病, 颅内出血, 卒中复发, 新型口服抗凝药