房颤抗凝 陈仁华.ppt

我国非瓣膜性房颤脑卒中的发生率 房颤抗凝治疗现状 在美国，适合抗凝治疗的患者中，1/3左右的患者没有用华法林，而应用华法林的患者中，半数以上的患者没有正规的监测 中国部分地区心房颤动住院病例回顾性调查中，住院患者的抗凝治疗率仅为6.6% 胡大一等进行的全国人群流行病学调查发现，我国房颤患者抗凝治疗率只有2% 日本华法林使用计量的研究 低剂量华法林（INR维持于1.6～2.6）抗凝治疗，严重出血和颅内出血发生率分别为每人年2.38%和每人年0.60%，显著高于西方人，INR≥2.27是严重出血的独立危险因素之一。 房颤导管消融恢复窦律改善预后 * Background—Warfarin is effective in the prevention of stroke in atrial fibrillation but is under used in clinical care. Concerns exist that published rates of hemorrhage may not reflect real-world practice. Few patients 80 years of age were enrolled in trials, and studies of prevalent use largely reflect a warfarin-tolerant subset. We sought to define the tolerability of warfarin among an elderly inception cohort with atrial fibrillation. Methods and Results—Consecutive patients who started warfarin were identified from January 2001 to June 2003 and followed for 1 year. Patients had to be 65 years of age, have established care at the study institution, and have their warfarin managed on-site. Outcomes included major hemorrhage, time to termination of warfarin, and reason for discontinuation. Of 472 patients, 32% were 80 years of age, and 91% had 1 stroke risk factor. The cumulative incidence of major hemorrhage for patients 80 years of age was 13.1 per 100 person-years and 4.7 for those 80 years of age (P0.009). The first 90 days of warfarin, age 80 years, and international normalized ratio (INR) 4.0 were associated with increased risk despite trial-level anticoagulation control. Within the first year, 26% of patients 80 years of age stopped taking warfarin. Perceived safety issues accounted for 81% of them. Rates of major hemorrhage and warfarin termination were highest among patients with CHADS2 scores (an acronym for congestive heart failure, hypertension, age 75, diabetes mellitus, and prior stroke or transient ischemic attack) of 3. Conclusions—Rates of hemorrhage derived from younger noninception cohorts underestimate the bleeding that occurs in practice. This finding coupled with the