房颤为什么要抗凝？PPT.ppt

上海长征医院心血管内科 廖德宁;中国AF患者抗凝现状：令人堪忧;原 因;房颤引起卒中？;房颤导致血栓栓塞：合理;房颤与卒中：密切相关;Several other Hill criteria do not support a straight forward relationship between AF and stroke.;Framingham 心脏研究： 年脑卒中率： 50-69岁1.5%→80-89岁?23.5%（平均4.9-6.9%）;Annualized adjusted rate of thromboembolism (ischemic stroke and peripheral embolism) during off-warfarin periods among women and men with AF with age, prior stroke, hypertension, CHF, CAD, DM, and estrogen use controlled for. Age cutoffs of ≦75 and ≥75 years used as in the SPAF analysis. ;血管疾病、年龄、女性与房颤卒中风险;CHA2DS2VASc评分;房颤与卒中的危险因素重叠;Updated Model for Mechanisms of Stroke in AF;房颤卒中致残率高于非房颤卒中;Stroke 1997;28:311-315;房颤相关卒中复发率高于非房颤;房颤对国人的危害;;缺血性脑卒中发生率--- ? 68% （女性84％，男性60％ ） 病死率 ------------ ? 33% 复合终点事件（脑卒中、周围动脉栓塞、死亡） ----------------- ? 48%;国际标准化比值（INR);华法林增加出血的危险与阿司匹林相当;亚洲/非亚洲人群接受华法林、达比加群、阿哌沙班后NNT及NNH比较;抗凝：贯穿房颤全部病程的措施;谢谢!;非瓣膜性房颤的危险因素;Stroke. 1991,983 ;?;抗凝药类型;新型口服抗凝药特点;;NOACs预防房颤卒中: 不劣于或优于 华法林;NOACs颅内出血风险： 显著小于华法林;大出血年发生率(%/年);中国人群如何个体化治疗?;　　 　“变老”是一个无罪但却不断遭受变本加厉的惩罚的过程 ;左房纤维化程度与房颤复发率Based on 3D Delayed Enhancement MRI Imaging Scans;ATRIA ;机械瓣膜患者禁用新型口服抗凝药;中国人群如何个体化治疗?;即使在临床研究中华法林治疗维持有效INR较难;CRYSTAL-AF试验：无症状性房颤与不明原因脑卒中;非瓣膜性房颤的危险因素;Stroke. 1991,983 ;房颤卒中的危险因素（CHADS2）;肾功能不全：房颤卒中独立危险因素;CRYSTAL-AF试验：无症状性房颤与不明原因脑卒中;Even if the origin of stroke in AF is accepted to be the left atrium, other atrial factors in addition to AF may cause thromboembolism.;;Updated Model for the Mechanisms of Stroke in AF;Conclusions;房颤引起卒中？AF as a Cause of Stroke;Several other Hill criteria do not support a straight forward relationship between AF and stroke.;Several other Hill criteria do not support a straight forward relationship between AF and stroke.;.;房颤与卒中之间的因果关联，实验结果不完全符合已有实验证据 Fourth, a causal interpretation of the association between AF and stroke does not adequately fit the available experimental evidence 如果心律紊乱是血栓栓塞的唯一原因，维持正常心律应该可以除外卒中风险。但是，8个随机临床研究的荟萃分析表明，节律控制方案对卒中风险无效， 该结果并不能简单地归结于节律控制策