心房颤动指南--抗凝治疗.pptVIP

特殊人群的抗凝治疗2 肥厚性心肌病： 启动抗凝治疗，不依赖CHA2DS2-VASc评分 特殊人群的抗凝治疗3 稳定型心绞痛与外周动脉疾病： 建议此类患者仅应用华法林治疗，最佳策略尚有待探讨。 心房纤颤发生栓塞的高发病率和较高的致死致残率，严重影响患者的生命及生活质量。 近年来随着心房颤动治疗理念的改变，对心房纤颤的抗凝治疗出现了革命性进展，2010年心房纤颤治疗指南就将治疗目标转变为降低患者死亡率、住院率及脑卒中，提高患者生存质量、心功能及活动耐量。治疗策略也调整为1.抗凝治疗2.心率/节律控制3.上游治疗，首次将抗凝治疗排在治疗策略第一位，因为有效抗凝将减少心房颤动导致的脑卒中以及降低患者死亡率而达到治疗目的。因此，当房颤的治疗目标进入降低死亡率、提高患者生存质量的新时代，抗凝治疗成为首要的治疗策略。 积分≥3分时提示“高危”，出血高危患者无论接受华法林还是阿司匹林治疗，均应谨慎，并在开始抗栓治疗之后定期复查 aHypertension’ is defined as systolic blood pressure .160 mmHg. ‘Abnormal kidney function’ is defined as the presence of chronic dialysis or renal transplantation or serum creatinine ≥200 mmol/L. ‘Abnormal liver function’ is defined as chronic hepatic disease (e.g. cirrhosis) or biochemical evidence of significant hepatic derangement (e.g. bilirubin胆红素 .2 x upper limit of normal, in association with转氨酶 aspartate aminotransferase/alanine aminotransferase/alkaline phosphatase .3 x upper limit normal, etc.). ‘Bleeding’ refers to previous bleeding history and/or predisposition to bleeding, e.g. bleeding diathesis, anaemia, etc. ‘Labile INRs’ refers to unstable/high INRs or poor time in therapeutic range (e.g. ,60%). Drugs/alcohol use refers to concomitant use of drugs, such as antiplatelet agents, non-steroidal anti-inflammatory drugs, or alcohol abuse, etc. * * * Source: Turpie State of the art presentation EFORT-08 (rivaroxaban, apixaban and dabigatran highlighted and all the others greyed out) Reference Weitz JI, Bates SM. New anticoagulants. J Thromb Haemost 2005;3:1843–1853 All of the drugs in the above figure are to be found in Weitz and Bates (2005) in Figure 2, apart from: Apixaban – this was called BMS-562247 in the original figure Betrixaban and YM150 – see Graham Turpie’s review paper: Turpie AGG. New oral anticoagulants in atrial fibrillation. Eur Heart J 2008;29:155–165 Otamixaban – Guertin KR, Choi YM. The discovery of the Factor Xa inhibitor otamixaban: from lead identification to clinical development. Curr Med Chem 2007;14:2471–2481 左心耳以其独特的结