房颤抗凝新进展 顾刚.ppt

阿司匹林等抗聚药物预防房颤卒中效果较弱，远不如华法林及新型抗凝药物 新型口服抗凝药物较安全，疗效等同或优 华法林，给房颤卒中的预防带来了新的希望 华法林是国内外首选的抗凝药物，如何提高华法林的使用率是我们面临的重要挑战 总 结 谢 谢！ 2、这是房颤最严重而常见的并发症。3、--因此房颤时心房功能丧失，心排血量降低15-30%，而这种情况比率在心衰时更高。4、植入ICD的患者记录到，房颤可诱发室颤导致猝死。 * Five large randomized trials published between 1989 and 1992 evaluated VKA mainly for the primary prevention of thrombo-embolism in patients with non-valvular AF. A sixth trial focused on secondary prevention among patients who had survived non-disabling stroke or TIA. In a meta-analysis, the RR reduction with VKA was highly significant and amounted to 64%, corresponding to an absolute annual risk reduction in all strokes of 2.7%.54 When only ischaemic strokes were considered, adjusted-dose VKA use was associated with a 67% RR reduction. This reduction was similar for both primary and secondary prevention and for both disabling and nondisabling strokes. * 房颤可分为瓣膜性房颤和非瓣膜性房颤。瓣膜性房颤首选维生素K拮抗剂进行治疗，非瓣膜性房颤65岁和孤立性房颤患者，包括女性则不进行抗栓治疗。CHA2DS2-VASc 评分大于或等于1分的患者应在评估出血风险后选择抗凝药物，且新型抗凝药物优先于维生素K拮抗剂。 * 荟萃分析显示---优于安慰剂。 * * ---与华法林对照，降低卒中风险远远不如华法林。 Reference: 1. Lip GYH et al. BMJ 2002; 325: 1022–1025. A meta-analysis of five trials directly compared full dose warfarin with ASA alone. The mean achieved INR ranged from 2.2 to 3.1 in the four primary prevention trials and was 2.9 in the single secondary prevention trial.1 The average rate of all strokes among ASA recipients was 2.7% per year in the primary prevention trials and 10.9% per year in the secondary prevention trial.1 Meta-analysis showed that adjusted-dose warfarin reduced overall relative risk for all stroke by 36% (CI, 14% to 52%) compared with ASA.1 When only ischemic strokes were considered, adjusted-dose warfarin was associated with a 46% (CI, 27% to 60%) relative risk reduction compared with ASA.1 Patients who received warfarin had more than twice as many intracranial hemorrhages than those who received ASA (17 compared with 7) (relative risk, 2.1 [CI, 1.0 to 4.6]).1 Major extracranial hemorrhage increased i