房颤患者卒中预防.ppt

? 利伐沙班 华法林 ? ? Event Rate Event Rate HR(95% CI) P On Treatment N= 14,143 1.70 2.15 0.79 (0.65,0.95) 0.015 ITT N= 14,171 2.12 2.42 0.88 (0.74,1.03) 0.117 利伐沙班好 华法林好 主要疗效终点 卒中和非中枢神经系统栓塞 AHA 2010 ITT=intention to treat 小 结 房颤是临床最常见的心律失常 高卒中率及卒中致残率、死亡率 抗栓（华法林）治疗可降低房颤卒中率 华法林因出血风险等局限性，患者及医生依从性低 华法林临床应用不足、INR达标率低 新型抗栓药物（利伐沙班等）有望取代华法林 谢谢！ 主要内容： 从心内科医生的角度来讲述，房颤是什么？ 房颤与卒中的关系？给患者带来什么样的危害？ 按照指南，应进行积极的预防，但是实际上当前预防率很低； 造成此种现状的很重要的一个原因就是，当前的预防手段很有局限性，所以医生不愿意处方，患者不愿意使用；即便使用，依从性也很低。 利伐沙班ROCKET AF结果的公布，将为患者提供一种新的房颤卒中预防手段：比现有预防手段，疗效更优；显著降低医生和患者都非常关注的颅内出血和致死性出血的发生率，因而从某种意义上讲，与现有预防手段相比，更为安全；使用非常方便，有利于提高患者对于治疗的依从性，减少卒中对患者及其家庭带来的伤害和损失，也因此减轻医疗负担。 * * 美国的患病人数估计 Background—Limited data exist on trends in incidence of atrial fibrillation (AF). We assessed the community-based trends in AF incidence for 1980 to 2000 and provided prevalence projections to 2050. Methods and Results—The adult residents of Olmsted County, Minnesota, who had ECG-confirmed first AF in the period 1980 to 2000 (n4618) were identified. Trends in age-adjusted incidence were determined and used to construct model-based prevalence estimates. The age- and sex-adjusted incidence of AF per 1000 person-years was 3.04 (95% CI, 2.78 to 3.31) in 1980 and 3.68 (95% CI, 3.42 to 3.95) in 2000. According to Poisson regression with adjustment for age and sex, incidence of AF increased significantly (P0.014), with a relative increase of 12.6% (95% CI, 2.1 to 23.1) over 21 years. The increase in age-adjusted AF incidence did not differ between men and women (P0.84). According to the US population projections by the US Census Bureau, the number of persons with AF is projected to be 12.1 million by 2050, assuming no further increase in age-adjusted incidence of AF, but 15.9 million if the increase in incidence continues. Conclusions—The age-adjusted incidence of AF increased significantly in Olmsted County during 1980 to 2000. Whether or not this rate of increase continues, the projected number of persons with AF for the United Sta