心房颤动抗栓基本治疗进展.ppt

心房颤动抗栓治疗进展;The Epidemiology of AF in China and other Countries;The Epidemic of Atrial Fibrillation;Prevalence of Stroke in Patients with NVAF Stratified by Age ;Efficacy of Warfarin in Atrial Fibrillation;;Anticoagulation of AF in Real-life ;;The Absolute Incidence of Bleeding ;Hemorrhage of in-hospital patients with NVAF in China;;The Dilemma of Anticoagulation Management;Balancing Risk and Benefit;Balancing Risk and Benefit;;Relative Distribution of Patients by applying differentrisk stratification schemes;Balancing Risk and Benefit;Variable Dose Response;This pathway illustrates genes thought to mediate the eVects of warfarin. It also depicts a simpli- Wed representation of the biotransformation of warfarin and vitamin K;VKORC1 Related to Dose of Warfarin;GENOTYPE VS STANDARD WARFARIN DOSING Couma-Gen Trial (N=206);;OBJECTIONS TO GENETIC TESTING: Warfarin;Models of AC Management;;;Balancing Risk and Benefit;;Recommendation of patients with indications of long-term oral anticoagulation after PCI;Balancing Risk and Benefit;左心耳堵闭术取代药物抗凝？;New anticoagulants;新型抗凝药物;Comparison of idraparinux with vitamin K antagonists forprevention of thromboembolism-Kaplan-Meier;新型抗凝药物-利伐沙班;;低危因素 中危因素 高危因素;结 论 ;谢谢;抗凝治疗的管理;严重出血的发生率;13559名房颤病人颅内出血的发生率;血栓栓塞和出血事件与INR;接受华法林治疗的房颤病人发生严重出血的危险因素：HEMORR2HAGES;ACC/AHA心房颤动指南2006;芬兰6家医院2003-2004调查;;房颤患者进行PCI的抗栓治疗;INR异常升高的处理建议;治疗与研究方向;;;;;Moderate-risk factors High-risk factorsage ≥75 previous strokehypertension mitral valve stenosisHeart failure prosthetic heart valve diabetes ;ACTIVE研究设计;ACTIVE W -- 主要终点Stroke, Non-CNS Systemic Embolism, MI Vascular Death;ACTIVE W结果-- 严重出血;ACTIVE W主要终点 ;高危房颤患者，三氟醋柳酸联合华法林优于单独抗凝或抗血小板，尤其是极高危AF患者（血栓栓塞事件），出血无显著差异。 联合抗凝治疗中，为减少出血可适当降低抗凝治疗强度，但INR1.8-1.9无效。 三氟醋柳酸（triflusal）600mg相当于阿司匹林300mg，但出血明显减少。 ;新型抗凝药物;直接凝血酶抑制剂－ximelagtran;-AMADEUS研究 -idraparinux ;达比加群－RELY;新型抗凝药物存在的问题;;VKORC1基因多态性与华法林的初始剂量相关;华法林的个体差异－基因多态性;围手术期抗凝;NASPEAF 研究设计;NASPEAF结果;口服直接凝血酶抑制剂预防房颤卒中;不良事件－肝酶升高;主要终点：卒中和栓塞(I