Novel oral anticoagulants for stroke prevention in atrial fibrillation: key trial findings and clinical implications.
心房細動の脳卒中予防のための新しい経口抗凝血薬：鍵となる試験所見と臨床的意義。
2013-01-11
Medical Clinic II, Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital, Am Busdorf 2, 33098 Paderborn, Germany. andreas.goette@med.ovgu.de
Abstract
Novel oral anticoagulants have the potential to improve stroke prevention in patients who have atrial fibrillation and an elevated risk of stroke by overcoming several limitations of warfarin, such as the need for regular monitoring and dose adjustment, and the existence of multiple drug interactions and dietary restrictions. In recently completed phase III trials in patients with non-valvular atrial fibrillation, common findings for dabigatran, rivaroxaban, and apixaban compared with warfarin included: risk reductions for stroke and systemic embolism, significantly fewer hemorrhagic strokes and intracranial hemorrhages, and reductions in mortality, although different trends were seen in several endpoints. However, the trials had important differences in terms of design, populations studied, and statistical analysis that preclude comparison between trials and should be considered when interpreting findings. In this article, data for novel anticoagulants are reviewed and some potential practical implications are highlighted.
非弁心房細動患者における最近完了された第３相試験では、ワルファリンと比較してダビガトラン、リバロキサバンとアピキサバンのための一般の所見は、以下を含んだ：異なる傾向がいくつかのエンドポイントで見られたが、脳卒中と全身性塞栓症のための減少、有意により少しの出血性脳卒中と頭蓋内出血と死亡率の減少の危険を冒す。
しかしながら、試験は、設計に関する重要な差、調査される集団と所見を解釈するとき、試験の間の比較を排除して、考慮されなければならない統計解析をした。
本論文では、新しい抗凝固剤のためのデータは概説される、そして、若干の潜在的実際的な意味は強調される。
