达比加群酯治疗ACS心房颤动的研究进展

我国流行病学调查显示,35岁及以上人群心房颤动加权患病率为0.71%,随年龄增长患病率明显增高,房颤人群的脑卒中风险明显高于非房颤人群,房颤的疾病负担是一个重要的公共卫生问题,而抗凝治疗能够降低房颤患者的血栓栓塞风险。达比加群酯作为新型口服抗凝药目前在临床上得到了应用。其口服后经胃肠吸收,在体内转化为有抗凝活性的达比加群,直接抑制凝血酶,阻止纤维蛋白原转化为纤维蛋白,从而抑制血栓形成。在非瓣膜病性心房颤动患者中,国内外研究均显示了达比加群酯与华法林比较,预防血栓栓塞不差于华法林,且出血性并发症、不良反应均低于华法林,对于老年房颤患者同样安全、有效。而且,依达赛珠单抗能够有效地逆转达比加群的抗凝作用,也提高了其的使用安全性。目前在急性冠脉综合征(ACS)心房颤动患者中使用达比加群酯的研究尚未显示出其绝对优势,现就近年来关于这方面的研究做一综述,为临床应用提供可参考依据。

Research progress of dabigatran ester used in treatment of ACS with atrial fibrilliation

Epidemiological survery in China shows that the weighted prevalence of atrial fibrillation(A F) in the Chinese population aged 35 years or older is 0.71%.The prevalence of AF significantly increased with age.The risk of stroke in patients with AF is significantly higher than that in people without AF.The disease burden of AF is a significant public health issue.Anticoagulant therapy can reduce the risk of thromboembolism in patients with AF.Dabigatran ester is used in clinical practice as a new oral anticoagulant.After oral administration,it is absorbed by gastrointestinal tract and transformed into dabigatran with anticoagulant activity in vivo,which directly inhibits thrombin,prevents fibrinogen transforming into fibrin,thus inhibiting thrombosis.About non-valvular AF patients,the domestic and foreign studies have shown that compared with warfarin,dabigatran ester is not inferior to warfarin on preventing thromboembolism,and its bleeding complications and adverse reactions are lower than warfarin.It is also safe and effective for elderly patients with AF.Moreover,idarucizumab can effectively reverse the anticoagulant effect of dabigatran and improve the safety of its use.Some studies about dabigatran ester used in AF patients with acute coronary syndrome(ACS) have not yet shown its absolute advantage at present.Now the research progressions of recent years are described in this review to provide a reference for clinical applications.