房颤的规范化抗凝治疗 PPT课件.pptVIP

华法林过量时的处理 INR 5，无明显出血，减量或停服一次 INR 5-9，停华法林l-2次；如病人出血危险性高，停用一次同时口服维生素K1（1-2.5mg） INR9但无明显出血，口服维生素K13-5mg，INR将在24-48小时内降低，必要时可重复使用 严重出血或INR20时，应用维生素K110 mg，静脉输注新鲜血浆和凝血酶原浓缩物 * 华法林过量时INR的回落情况 INR 3~4，平均需要停药2天; INR4.0，需要停药4~5天 安贞医院房颤中心 * 华法林应用注意事项 可空腹也可和食物混食 尽可能晚上用 剂量差异大 INR3天,每周2次至稳定,每周1次,每2周1次,每月1次 头日漏食,第2日不需加量;连续2日以上漏食,应监测 忌易伤运动 食物相对固定,忌中草药及茶 大手术5-7天前停,拔牙提前3天停 房颤有血栓栓塞危险因素者肝素替代 厂家区别 …… * 谢谢 *Background— Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a source of considerable morbidity and mortality, but lifetime risk for AF has not been estimated. Methods and Results— We included all participants in the Framingham Heart Study who were free of AF at index ages of 40 years and older. We estimated lifetime risks for AF (including atrial flutter) to age 95 years, with death free of AF as a competing event. We followed 3999 men and 4726 women from 1968 to 1999 (176 166 person-years); 936 participants had development of AF and 2621 died without prior AF. At age 40 years, lifetime risks for AF were 26.0% (95% CI, 24.0% to 27.0%) for men and 23.0% (21.0% to 24.0%) for women. Lifetime risks did not change substantially with increasing index age despite decreasing remaining years of life because AF incidence rose rapidly with advancing age. At age 80 years, lifetime risks for AF were 22.7% (20.1% to 24.1%) in men and 21.6% (19.3% to 22.7%) in women. In further analyses, counting only those who had development of AF without prior or concurrent congestive heart failure or myocardial infarction, lifetime risks for AF were approximately 16%. Conclusions— Lifetime risks for development of AF are 1 in 4 for men and women 40 years of age and older. Lifetime risks for AF are high (1 in 6), even in the absence of antecedent congestive heart failure or myocardial infarction. These substantial lifetime risks underscore the major public health burden posed by AF and the need for further investigation into predisposing conditions, preventive strategies, an