房颤抗凝治疗(E).pptVIP

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房颤抗凝治疗(E).ppt

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房颤抗凝治疗(E)

Section 16:Anticoagulation for the Long-term Management of Atrial Fibrillation Anticoagulation for the Long-term Management of AF Discussion Points Review the results of the stroke-prevention trials in AF Discuss the risks/benefits of antithrombotic therapy Review the current guidelines for anticoagulation therapy pre- and post-cardioversion Multiple Thrombi in AF AF Investigators: Meta-analysisPatient Characteristics AF Investigators: Meta-analysisWarfarin for Stroke Prevention AF Investigators: Meta-analysisBleeding Rates Risk-Stratification Schemes AFI Analysis SPAF III High-Risk Prior TIA/stroke Prior TIA/strokeFeatures (RF) History of hypertension Systolic BP 160 mmHg Diabetes Impaired LV function* Increasing age Women 75 y Rate of Ischemic Stroke or Systemic Embolism Anticoagulation and Stroke Risk Underutilization of Warfarin Anticoagulation Guidelines for Cardioversion AF 48 hours?duration Pre-cardioversion: 3 weeks?anticoagulation Post-cardioversion: 4 weeks?anticoagulation Target INR, 2.5; range, 2? Manage atrial flutter similarly to AF Age Risk Factors* Recommendation 65 y Absent Aspirin Present Warfarin? 65?5 y Absent Aspirin or warfarin Present Warfarin 75 y All patients Warfarin Frequently Asked Questions 1. Is aspirin effective for preventing stroke in AF? 2. When should a patient with acute AF be anticoagulated? Answers 1. Is aspirin effective for preventing stroke in AF? Yes. However not as effective as warfarin. 2. When should a patient with acute AF be anticoagulated? AF 48 hours: cardioversion without anticoagulation AF 48 hours: Pre-cardioversion: 3 weeks?anticoagulation or heparin and TEE Post-cardioversion: 3 weeks?anticoagulation Common Misconceptions All patients with AF require anticoagulation. Stop warfarin in patients who have been back in sinus rhythm for 3 months and are well controlled on antiarrhythmic therapy. Since there is an increased risk of bleeding with warfari