老年抗凝治疗临床实践新型抗凝剂--临床病例分享.ppt

出血风险预测 抗凝发生出血是困扰医生的临床难题，准确识别高危患者是进行干预的前提！ HAS-BLED出血风险积分 字母 临床特点 计分 H 高血压 1 A 肝、肾功能异常（各1分） 1或2 S 卒中史 1 B 出血史 1 L INR值波动 1 E 老年（如年龄＞65岁） 1 D 药物或嗜酒（各1分） 1或2 最高值9分 积分≥3分，提示出血高危！须警惕，并定期复查 ESC guideline 2010 老年人抗凝--思考？？? 老年人常合并多种疾病，活动少，血管条件差，危险因素多并持续存在，易发生动静脉血栓。多为血栓高危人群，需要长期抗聚、抗凝治疗。 但同时也是出血高发人群，尤其高龄老年人积极治疗较困难 医生及病人均有顾虑 积极行出血风险的评估，可以减少出血的发生 新型抗凝剂-安全有效尤为重要，将成为老年长期抗凝治疗首选方法，但需要注意肝肾功能。 长期抗凝加抗聚治疗-安全性对于高龄老年人还需探讨和长时间的考验 * The first area of high unmet medical need is thrombosis. The ability of blood to clot is of course a very important natural property, without which we would not be able to survive. However, under certain conditions, blood may clot while still inside the blood vessel which is a serious, life threatening medical condition. Deep vein thrombosis (DVT), is a clot in the deep veins, usually in the legs. The blood clot may detach and lodge in another part of the blood circulatory system like blood vessels in the lungs and lead to a very serious, life-threatening condition called pulmonary embolism (PE). Very often, blood clots in the veins are formed silently and commonly after surgeries such as hip replacements or knee surgery. There may be no obvious symptoms such as pain or breathlessness. These silent, large clots can break away, float in the veins and then get lodged in the lungs causing what is called a pulmonary embolus, or PE for short. A PE is a serious, often fatal condition and is the commonest cause of sudden death after surgery. This life-threatening event could be prevented if we had the right treatment to stop the abnormal formation of blood clots, in the first place. The same problem can arise with small clots forming in the heart under certain medical conditions such as after a heart attack or with rhythm problems such as fibrillation. Small pieces of these clots can cause further heart attacks or strokes if they float up to the brain. Again, these are serious complications. The Framingham Heart Study evaluated the impact of the