心房颤动（房颤）导致的卒中是其严重并发症，非瓣膜性房颤导致脑梗死患者并发癫痫的风险比其他原因卒中患者更高，可能需要利伐沙班联合抗癫痫药物治疗。新型口服抗凝药物利伐沙班是口服直接Xa因子抑制剂，同时是CYP3A4和P-糖蛋白（P-gp）的底物，某些抗癫痫药物对CYP3A4和/或P-gp有诱导作用，与利伐沙班合用，可使利伐沙班血药浓度下降，血栓风险增加。对利伐沙班与丙戊酸钠、卡马西平、苯巴比妥、奥卡西平、左乙拉西坦以及其他抗癫痫药物合用的相互作用进行综述，并根据相关研究和病例报道给出推荐意见，为临床合理用药提供参考。

Stroke caused by atrial fibrillation is a serious complication. Patients with cerebral infarction due to non-valvular atrial fibrillation have a higher risk of epilepsy than patients with other causes of stroke. Treatment may require rivaroxaban combined with antiepileptic drugs. Rivaroxaban, a novel oral anticoagulant, is an oral direct factor Xa inhibitor and a substrate of CYP3A4 and P-glycoprotein (P-gp). Some antiepileptic drugs induce CYP3A4 and/or P-gp, and when combination with rivaroxaban, they can reduce rivaroxaban plasma concentrations and increase the risk of thrombosis. This article reviews the interaction of rivaroxaban combination with sodium valproate, carbamazepine, phenobarbital, oxcarbazepine, levetiracetam, and other antiepileptic drugs. Based on relevant studies and case reports, this paper provides recommendations for clinical rational drug use.

R971

天津市卫生健康科技项目(KJ20143)