心力衰竭患者的抗凝治疗PPT.ppt

A global observational study of venous thromboembolism risk and prophylaxis in the acute care hospital setting 最新流行病学研究结果发布于2007年7月在瑞士日内瓦举行的ISTH（国际血栓和止血大会） ENDORSE研究： 全球首个观察真实世界VTE预防状况的大规模研究 ENDORSE : A worldwide study 32 countries - 358 hospitals First patient enrolled August 2, 2006 Last patient enrolled January 4, 2007 Patients at risk for VTE in 32 countries N= 68,183 Mean = 52% Patients at risk for VTE receiving recommended prophylaxis in 32 countries Mean = 50% N= 35,329 Surgical vs Medical Patients ( N = 68,183 ) Surgical (N =30,827) Medical (N =37,356) Primary objectives 42 % at Risk for VTE Medical ( n = 37,356 ) Secondary objectives 40 % receiving ACCPRec. Px 64 % at Risk for VTE 59 % receiving ACCPRec. Px Surgical ( n = 30,827 ) 内科危险人群接受VTE预防的比率低于外科患者 52 % at Risk for VTE 50 % receiving ACCPRec. Px Overall ( N= 68,183 ) 全球估计仅41%心衰患者接受了VTE预防 ? Surgical ? Medical 88 82 66 59 47 Hip / Knee Replacement Hip Fracture Gastric Colon Urologic 45 41 40 25 Acute Respiratory Disease Acute Heart Failure Pulmonary Infection Ischemic Stroke 0 25 50 75 100 % 0 25 50 75 100 % 小 结 DVT是CHF病人背后的隐形杀手 LMWH对CHF病人DVT的预防是安全有效的 小结：我们面临的挑战 我国尚缺乏大样本的心衰患者DVT/PE发生率的流行病学资料 我国尚缺乏预防治疗DVT/PE的前瞻性的临床研究资料 临床心血管医生对于DVT/PE的防治还缺乏足够的认识 The first model of Howell et al., in which CHF was considered as a dichotomous variable, established that HF was an independent risk factor for VTE. The second model found that the risk of VTE increased with decreasing LV function. This is consistent with the observation that plasma levels of proinflammatory and procoagulant factors increase with increasing severity of CHF. (Chin et al. 2003) References: Chin BS, Conway DS, Chung NA, Blann AD, Gibbs CR, Lip GY. Interleukin-6, tissue factor and von Willebrand factor in acute decompensated heart failure: Relationship to treatment and prognosis. Blood Coagul Fibrinolysis. 2003;14:515 – 521. Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: