2016esc房颤指南卒中防治教学课件.ppt

年龄50岁，肥厚型心肌病、代谢综合征、呼吸睡眠暂停综合征 Oral anticoagulant,OAC Oral anticoagulant,OAC 罹?[lí] * 美国卒中量表, * Oral anticoagulant,OAC Oral anticoagulant,OAC Pcc 凝血酶原复合物 FFP: 新鲜的冰冻血浆 If the intake of NOAC was recent(,2–4 h), charcoal administration and/or gastric lavage will reduce further exposure. Dialysis clears dabigatran but is less effective for the other NOACs. Contra-indication Consider further information to allow informed judgement for OAC Initiate or resume OAC, choosing an agent with low intracranial bleeding risk, after 4–8 weeks (IIbB) No stroke protection (no evidence) LAA occlusion (IIbC) Factors supporting withholding of OAC: Bleeding occured on adequately dosed NOAC or in setting of treatment interruption or underdosing Older age Uncontrolled hypertension Cortical bleed Severe intracranial bleed Multiple microbleeds (e.g. 10) Cause of bleed cannot be removed or treated Chronic alcohol abuse Need for dual antiplatelet therapy after PCI Factors supporting reinitiation of OAC: Bleeding occured on VKA or in setting of overdose Traumatic or treatable cause Younger age Well controlled hypertension Basal ganglia bleed No or mild white matter lesions Surgical removal of subdural haematoma Subarachnoid bleed: aneurysm clipped or coiled High-risk of ischaemic stroke Patient with AF suffering from an intracranial bleed on OAC If acute event: establish intensity of anticoagulation (see bleeding flow chart) Patient or next of kin choice informed by multidisciplinary team advice VKA = vitamin K antagonist. Figure 10 Initiation or resumption of anticoagulation in atrial fibrillation patients after an intracranial bleed. This approach is based on consensus opinion and retrospective data. In all patients, evaluation by a multidisciplinary panel is required before treatment (stroke physician/neurologist, cardiologist, neuroradiologist, and neurosurgeon). Page 32 of 90 ESC Guidelines Downloaded from / by guest on September 7, 2016 * Pcc 凝血酶原复合物 FFP: 新鲜的冰冻血浆 If the intake of NO