新しい抗凝固薬を巡る話題「心房細動に伴う血栓塞栓症予防と新しい抗凝固薬の役割」１．心房細動における血栓形成のメカニズムと抗凝固薬の標的

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• Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence increases with age. AF is strongly associated with increased risk of vascular events, especially stroke due to thromboembolism. Warfarin is highly effective in preventing thromboembolism clinically, not only ischemic stroke but also systemic thromboembolism. Nonetheless, warfarin increases the risk of major hemorrhage and is very burdensome in practice to maintain the optimal level of anticoagulant intensity for both physicians and patients.<BR>The limitations of warfarin highlight the unmet need for new anticoagulants in the prevention of stroke in patients with AF. Therefore, new anticoagulants have been developed as a result of tireless pursuit for an ideal anticoagulant for long-term use in AF. These novel anticoagulant agents selectively inhibit the active form of a single factor in the coagulation cascade. Among the numerous classes of new drugs, direct thrombin inhibitors and Xa inhibitors have been most successful in the prevention of thromboembolism in patients with AF.<BR>Old and current evidence suggests that formation of thrombi is the result of three components known as"Virchow's triad" (i.e., hypercoagulable state, an abnormal blood flow, and endothelial dysfunction). These components are all present in patients at high risk of AF. Anticoagulant therapy has been shown to be an effective countermeasure against a hypercoagulable state. Normalization of blood flow by rhythm control or atrial appendage closure is the second strategy for prevention of thromboembolism. However, the third factor in Virchow's triad, endothelial dysfunction, has not yet been studied specifically as a therapeutic target. Inflammation plays a role in endothelial dysfunction. Inflammation and thrombogenesis in patients with AF should be discussed.

• 一般社団法人 日本臨床薬理学会の論文

一般社団法人 日本臨床薬理学会 | 論文

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