心房颤动血栓防治董建增课件.pptVIP

Dabigatran VS. 华法林：RE-LY 研究 Ximelagatran 功败垂成 非风湿性AF左房血栓90%位于LAA 犬左心耳封堵后内膜光滑 PROTECT-AF研究WATCHMAN-LAA封堵术预防卒中 封堵术VS华法林非劣势随机对照临床研究 入选患者：非瓣膜性房颤患者(美欧59个中心) 封堵术组：463名 ，45d、6m和1y行TEE 成功率是90.9%（408/449） 华法林组：244名，INR的目标值范围2-3 临床随访5年（1065人年 = 平均18个月） 主要安全终点：出血、手术相关并发症 主要效果终点：卒中、心血管死亡、体栓塞 有效性和安全性 有效性和安全性 堵闭治疗成功者与华法林对比 导管消融减少脑卒中的风险 消融后无房颤、无间歇、无晕厥、无抗凝 “Warfarin’s days are numbered!” From: Dr. Michael Ezekowitz of Lankenau Institute for Medical Research in Wynnewood, PANew anticoagulants drugs are being developed. We should use the window of opportunity we have today From: CoaguChek Roche 2008 告别华法林时代？ 虽然RE-LY研究证实Dabigatran的有效性，但是研究结果不是药物判断的终点，而是广泛被评价的起点，Ximelegatran的经历不能忘记，另外新药价格昂贵 左心耳堵闭后左心耳机械功能丧失，对心功能不利，尤其是对舒张功能不全者有害，因此应用空间可能仅仅限于无恢复窦性心律可能性的高龄患者 导管消融虽然针对房颤全部危害，全面避免抗凝药物，但是年1万例导管消融 VS 1000万患者杯水车薪 小结 部分房颤患者已经告别了令人烦恼华法林 华法林暂时不会告别众多的房颤患者 New method of predicting stroke in heart patients St. Louis, June 13, 2001 — Researchers at Washington University School of Medicine in St. Louis have developed a formula to predict the risk of stroke in patients with an irregular heart rhythm called atrial fibrillation. “Our hope is that this new classification scheme will help physicians select the appropriate course of treatment for patients with atrial fibrillation,” says Brian F. Gage, M.D., who led the study. Gage is assistant professor of medicine at the School of Medicine and medical director of Barnes-Jewish Hospital’s blood thinner clinic. The results are published in the June 13 issue of the Journal of the American Medical Association. Patients with atrial fibrillation, an irregular, uncoordinated contraction of heart muscles, are estimated to have a fivefold increased risk of stroke. A blood thinner called warfarin sodium (sold as Coumadin? and others) often is used to reduce this risk, but the drug itself can cause hemorrhage and other side effects. It also is more expensive and more difficult to administer and monitor than the alternative