2014房颤指南课件.ppt

之后使用氯吡格雷和口服抗凝药物联合，不推荐阿斯匹林 * 否 * Page 40 of 123（Ahmed I, Gertner E, Nelson WB, et al. Continuing warfarin therapy is superior to interrupting warfarin with or without bridging anticoagulation therapy in patients undergoing pacemaker and defibrillator implantation. Heart Rhythm. 2010;7:745-9.） For patients who are treated with warfarin and who are at low risk of thromboemboli, or are back in normal sinus rhythm and are undergoing surgical or diagnostic procedures that carry a risk of bleeding, stopping warfarin for up to 1 week and allowing the INR to normalize without substituting UFH is a recognized approach. Warfarin is then resumed after adequate hemostasis has been achieved. For patients at higher risk of thromboembolism (mechanical valves, prior stroke, CHA2DS2-VASc score ≥2), bridging with UFH or LMWH is a common practice, although data for LMWH are limited (23). An increasingly common approach, especially for pacemaker or implantable cardioverterdefibrillator implantation, catheter ablation, coronary angiography, and other vascular interventions, is to perform the procedure without interrupting warfarin (234, 236-240). Radiofrequency catheter ablation of AF performed with a therapeutic INR does not increase bleeding risk and reduces the risk of emboli (236, 237). Pacemaker or defibrillator implantation with a therapeutic INR has a lower risk of postoperative bleeding than discontinuing warfarin and initiating bridging anticoagulation with UFH or LMWH, and may be considered in those patients requiring device implantation who also have a moderate-to-high thromboembolic risk * Page 41 of 123 In patients undergoing percutaneous coronary intervention, dual antiplatelet therapy with aspirin and clopidogrel is indicated to prevent stent thrombosis. The combination of oral anticoagulants and antiplatelet therapy (“triple therapy”) is associated with a high annual risk of fatal and nonfatal bleeding episodes (244-247). Recently, in patients taking oral anticoagulants u