华法林抗凝.ppt

Guidelines on oral anticoagulation with warfarin – fourthedition 1.Indications for warfarin and recommended target international normalized ratio (INR) 1.1Venous thromboembolism (VTE) ? First episodes of VTE should be treated with an INR target of 2.5 (1A). ? Warfarin used for treatment of VTE should be introduced along with parenteral anticoagulation (1A) which should continue for at least 5 d and until the INR is ≥2 for at least 24 h (1C). ? Recurrent VTE whilst anticoagulated and within the therapeutic range should be managed by increasing the INR target to 3.5 (2C). 1.2 Antiphospholipid syndrome (APS) ? The target INR should be 2.5 in patients with antiphospholipid antibodies (1A). 1.3 Atrial fibrillation (AF) ? Patients with AF who require warfarin for the prevention of cardio-embolic should have an INR target of 2.5 (1A). 1.4 Cardioversion ? Patients undergoing elective cardioversion should be anticoagulated with warfarin for at least 3 weeks prior to and 4 weeks post cardioversion with a target INR of 2.5 (2C). To minimize cardioversion cancellations due to low INRs on the day of the procedure a target INR of 3.0 can be used prior to the procedure. 1.5 Valvular heart disease and prosthetic valves 1.5.1 Mitral stenosis or regurgitation. ? Patients with mitral stenosis or regurgitation who have atrial fibrillation (1A) or a history of systemic embolism (1A) or left atrial thrombus (1A) or an enlarged left atrium (2C) should receive warfarin with an INR target of 2.5. 1.5.2 Mechanical prosthetic heart valves. The recommended target INRs for mechanical heart valves are given in Table I. ? In situations where an embolic event occurs during anticoagulation within target, elevation of the INR target or the addition of anti-platelet drugs should be considered (2C). Table I. Recommended target INRs for mechanical heart valves (GRADE 2B) *Prosthesis thrombogenicity: Low: Carbomedics (aortic position), Medtronic Hall, St Jude Medical (without silzone); Me