Patients with atrial fibrillation and prior stroke or transient ischemic attack exhibit a very high risk of recurrence. Secondary prevention with oral anticoagulants is mandatory. Overall, clinical guidelines recommend the use of target-specific oral anticoagulants over vitamin K antagonists for secondary prevention of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation and previous stroke are not receiving the appropriate antithrombotic treatment, perhaps due to the perceived risks of anticoagulation including the risk of hemorrhagic transformation of an ischemic stroke. The ENGAGE AF-TIMI 48 trial showed that although edoxaban 60 mg and warfarin reduced the risk of stroke to a similar extent, edoxaban exhibited a lesser risk of bleeding, particularly intracranial hemorrhage. Importantly, these data were independent of the presence of prior stroke or transient ischemic attack. Therefore, edoxaban can be used in both primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. The aim of this review was to update the available evidence about edoxaban in the clinical management of secondary prevention in individuals with non-valvular atrial fibrillation.

译文

:患有房颤和先前中风或短暂性脑缺血发作的患者表现出很高的复发风险。口服抗凝剂的二级预防是强制性的。总体而言,临床指南建议使用特定于目标的口服抗凝剂,而不是维生素K拮抗剂,对房颤患者的卒中进行二级预防。但是,许多患有房颤和先前卒中的患者未接受适当的抗血栓治疗,可能是由于人们认为存在抗凝风险,包括缺血性卒中发生出血性转化的风险。 ENGAGE AF-TIMI 48试验显示,尽管60毫克edoxaban和华法林可降低中风的风险,但edoxaban出血的风险较小,尤其是颅内出血。重要的是,这些数据与既往中风或短暂性脑缺血发作的存在无关。因此,edoxaban可用于非瓣膜性房颤患者的一级和二级卒中预防。这篇综述的目的是在非瓣膜性房颤患者的二级预防的临床管理中,更新有关依多沙班的现有证据。

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