课件：心房颤动抗栓治疗进展.ppt

* * * There are many targets for novel anticoagulants in the coagulation pathway: Tissue factor pathway inhibitor (TFPI) bound to Factor Xa inactivates the tissue factor (TF)–Factor VIIa complex. preventing initiation of coagulation Activated protein C (APC) degrades Factors Va and VIIIa. and thrombomodulin (soluble; sTM) converts thrombin (Factor IIa) from a procoagulant to a potent activator of protein C Fondaparinux and idraparinux indirectly inhibit Factor Xa. requiring antithrombin (AT) as a cofactor Direct (AT-independent) inhibitors of Factor Xa include rivaroxaban (BAY?59-7939). LY517717. YM150 and DU-176b (all orally available). and DX-9065a (intravenous) Oral. direct thrombin inhibitors include ximelagatran (now withdrawn) and dabigatran Weitz JI Bates SM. New anticoagulants. J Thromb Haemost 2005;3:1843–1853 * * * * * * * * * * * * * * * * * * * * * * * * * 栓塞+出血 * Eligible(n=3944) ineligible(n=562) No antithrombotic 37 47.3 OAC+antiplatelet 4.6 4.3 OAC 5.2 4.6 aspirin 53.5 43.7 * * * *The adjusted stroke rate was derived from multivariate analysis assuming no aspirin usage. Data from van Walraven C, Hart RG, Wells GA, et al. A clinical prediction rule to identify patients with atrial fibrillation and a low risk for stroke while taking aspirin. Arch Intern Med 2003; 163:936-43, and Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285:2864-70.AF = atrial fibrillation; CHADS2 = Cardiac Failure, Hypertension, Age, Diabetes, Stroke (Doubled) stroke risk index; CI = confidence interval; TIA = transient ischemic attack. * compare 12 published schemes that stratify stroke risk in patients with nonvalvular atrial fibrillation Seven of the 12 schemes were