特殊情况的抗栓治疗-台州.pptVIP

特殊情况的抗栓治疗 浙江大学医学院 附属邵逸夫医院神经科 胡 兴 越 特殊情况的抗栓治疗 缺血性脑卒中脑出血转化 颅内出血 房颤合并冠心病 围手术期管理 缺血性脑血管疾病患者抗栓治疗 缺血性脑卒中脑出血转化 HI 出血性梗死： HI1 小点状出血 HI2 多个融合的点状出血 PH 脑实质出血 PH1 ≤30%梗死灶有轻微占位效应出血 PH2 ＞30%梗死灶有明显占位效应出血或远离梗死灶出血 缺血性脑卒中出血转化的抗栓治疗 缺血性脑卒中出血转化的抗栓治疗 特殊情况的抗栓治疗 缺血性脑卒中脑出血转化 颅内出血 房颤合并冠心病 围手术期管理 缺血性脑血管疾病患者抗栓治疗 特殊情况的抗栓治疗 缺血性脑卒中脑出血转化 颅内出血 房颤合并冠心病 围手术期管理 缺血性脑血管疾病患者抗栓治疗 For patients with AF and stable coronary artery disease (eg, no acute coronary syndrome within the previous year) who choose oral anticoagulation suggest adjusted-dose VKA therapy alone (target INR range, 2.0-3.0) rather than the combination of adjusted-dose VKA therapy and aspirin (Grade 2C) For patients with AF at intermediate to high risk of stroke (eg, CHADS2 score ≥ 1) who experience an acute coronary syndrome and do not undergo intracoronary stent placement suggest for the first 12 months adjusted-dose VKA therapy (INR 2.0-3.0) plus single antiplatelet therapy rather than dual antiplatelet therapy (eg, aspirin and clopidogrel) or triple therapy (eg, warfarin, aspirin, and clopidogrel) (Grade 2C). For patients with AF at intermediate to high risk of stroke After the first 12 months antithrombotic therapy is suggested as for patients with AF and stable coronary artery disease For patients with AF at high risk of stroke (eg, CHADS2 score ≥ 2) during the first month after placement of a bare-metal stent or the first 3 to 6 months after placement of a drug-eluting stent suggest triple therapy (eg, VKA therapy, aspirin, and lopid-ogrel) rather than dual antiplatelet therapy(eg, aspirin and clopidogrel) (Grade 2C) For patients with AF at high risk of stroke After this initial period of triple therapy suggest a VKA (INR 2.0-3.0) plus a single antiplatelet drug rather than VKA alone (Grade 2C) . 12 months after intracoronary stent placement antithrombotic therapy is suggested as for patients with AF and stable coronary artery disease patients with nonvalvular AF CHA2DS2-VASc score is recommended for assessment