中国房颤卒中预防现状和对策-来自心内科医生的观点.pptVIP

是否根据房颤类型决定抗凝？ A 是 B 否 死亡率和临床事件发生率有症状AF vs 无症状AF A 相同 B 不同 如何判断房颤患者是否需要抗凝治疗？ A 房颤类型和临床症状 B 危险因素 小剂量阿司匹林能否预防低危房颤卒中 A 能 B 否 NEJM 2011 epub 阿派沙班212例，1.27%/年 华法林265例，1.60%/年 P（非劣效性）＜0.001 P（优效性）=0.011 阿派沙班降低栓塞发生风险(ARISTOTLE) 房颤的上游治疗 上游治疗： ACEI/ARB、醛固酮拮抗剂、他汀、PUFAs（多聚不饱和脂肪酸） 一级预防： 预防或延迟与高血压、心衰、炎症 （术后AF等相关的心肌重构从而预防新发房颤 二级预防： 降低房颤转复后复发的几率，或延缓阵发性AF转变为永久性AF 房颤是高发的疾病 房颤是卒中的独立危险因素 房颤导致的卒中致死性、致残性更高 口服抗凝药物是房颤卒中预防最有效的手段 由于VKA局限性使得中国房颤抗凝严重不足，新型口服抗凝药物的出现将给房颤卒中预防带来新的希望 总 结 * The Framingham Heart Study evaluated the impact of the presence or absence of coronary heart disease, hypertension, heart failure, and non-rheumatic AF on the incidence of stroke This analysis demonstrated that the presence of coronary heart disease more than doubled the risk of stroke (risk ratio 2.4), the presence of hypertension more than tripled the risk of stroke (risk ratio 3.4) and heart failure more than quadrupled the risk of stroke (risk ratio 4.3). However, of all these factors, AF was the most important independent risk factor for stroke, increasing stroke risk almost 5-fold (risk ratio 4.8) AF is associated with a risk of thrombus formation in the left atrium. Such thrombi can embolize to the brain, resulting in an ischemic stroke. The pathogenesis of intra-cardiac thrombus formation in patients with AF is multifactorial and relates to the fulfilment of Virchow’s classic triad (stasis of blood in fibrillating atria, atrial endocardial damage and abnormal changes in blood constituents), which together perpetuate a hypercoaguable state Abbreviation AF, atrial fibrillation References Wolf et al. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–988. Watson et al. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 2009;373:155–166. * The number of patients with AF is anticipated to increase The elderly now make up a larger proportion of the world population t