杨新春教授心房颤动抗凝治疗进展天津会课件.pptVIP

心房颤动抗栓治疗进展 首都医科大学附属北京朝阳医院 心脏中心 杨新春 房颤抗凝现状及问题 房颤病人栓塞的危险分层 房颤抗凝治疗新指标 治疗窗内时间 TTR(Time in Therapeutic Range) 口服华法林期间达到目标INR时间的百分比 分析评价口服抗凝剂的疗效差异 双联抗血小板预防房颤血栓 新抗凝药物预防房颤血栓 药物基因学对抗凝药物的影响 长期口服抗凝药的房颤患者 冠脉支架术后抗血栓治疗 房颤患者支架术后抗栓治疗的现状 临床不少见，但尚缺乏有力的循征医学证据指导临床。12项相关研究中，除2项多中心注册研究（GRACE和CRUSADE）的后续分析外，多数为小样本的单中心回顾性研究 1. 首先评价患者的出血风险 门诊出血危险指数（最高4分） ： 如存在以下危险因素每项计1分：年龄≥65岁、既往脑卒中病史、既往出血史； 如存在以下危险因素其中任何一项计1分：红细胞比容30%或血清肌酐1.5mg/dL或糖尿病 评分为0时年出血风险为3%，为低危患者； 评分为1-2时年出血风险为8-12%，为中危患者； 评分为3-4时年出血风险为30-48%，为高危患者。 谢谢！ * * * Benefit of Oral Anticoagulant Over Antiplatelet Therapy in Atrial Fibrillation Depends on the Quality of International Normalized Ratio Control Achieved by Centers and Countries as Measured by Time in Therapeutic Range Background— Oral anticoagulation (OAC) therapy is effective in atrial fibrillation but requires vigilance to maintain the international normalized ratio in the therapeutic range. This report examines how differences in time in therapeutic range (TTR) between centers and between countries affect the outcomes of OAC therapy. Methods and Results— In a posthoc analysis, the TTRs of patients on OAC in a randomized trial of OAC versus clopidogrel plus aspirin (Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events [ACTIVE W]) were used to calculate the mean TTR for each of 526 centers and 15 countries. Proportional-hazards analysis, with and without adjustment for baseline variables, was performed, with patients stratified by TTR quartile and country. A wide variation in TTRs was found between centers, with mean TTRs for centers in the 4 quartiles of 44%, 60%, 69%, and 78%. For patients at centers below the median TTR (65%), no treatment benefit was demonstrated as measured by relative risk for vascular events of clopidogrel plus aspirin versus OAC (relative risk, 0.93; 95% confidence interval, 0.70 to 1.24; P=0.61). However, for patients at centers with a TTR above the study median, OAC had a marked benefit, reducing vascular