达比加群从指南到实践.pptVIP

来自阜外医院未发表的数据 * * * Warfarin reduces relative risk of stroke compared with ASA In a meta-analysis of five trials comparing warfarin with ‘Aspirin’, which enrolled 2,837 patients with AF, warfarin reduced the relative risk of all stroke by 36% and the relative risk of ischaemic stroke by 46% compared with ‘Aspirin’.1 While ‘Aspirin’ is effective at preventing less severe, non-disabling stroke it is less effective at providing protection from disabling stroke.2 Despite its limited efficacy, ‘Aspirin’ is widely used as a monotherapy for stroke prevention in AF patients as it is inexpensive, convenient, and has a predictable and consistent effect. However, ‘Aspirin’ can have adverse effects, including gastrointestinal complications, an increase in the risk of bleeding, and allergic reactions. VKAs are currently the therapy of choice in patients with a moderate–high risk of stroke, as reflected in the ACC/AHA/ESC and ACCP guidelines.3,4 AFASAK, Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Therapy Study; EAFT, European Atrial Fibrillation Trial; PATAF, Primary Prevention of Arterial Thromboembolism in Nonrheumatic Atrial Fibrillation study SPAF, Stroke Prevention in Atrial Fibrillation study RFEFERENCES Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 1999;131:492–501. Lip GYH, Hart RG, Conway DS. Antithrombotic therapy for atrial fibrillation. BMJ 2002;325:1022–1025. Fuster V, Rydén LE, Cannom DS et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary. Circulation 2006;114:700–752. Singer DE, Albers GW, Dalen JE et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008;133:546s–592s. 华法林使用TTR70%相对TTR30,可以显著降低卒中发生风险。图表现实：如果华法林TTR过低，预防卒中甚至不如不使用华法林 * 达比加群为全新的直接凝血酶抑制剂,以浓度依赖的方式特异性阻断凝血酶(游离型或血栓结合型)活