心房颤动患者的抗凝治疗应该更关注疗效.pptVIP

我方的观点：房颤抗凝治疗，应更关注其疗效 在卒中高危因素中，房颤卒中风险最高，其致死率、致残率最高； 华法林显著减少卒中发生率68%，死亡率降低26%；致死性出血发生率0.5%； 各大指南强调了抗凝及INR达标的重要性； 新型抗凝药抗凝效果不劣于华法林，致死性出血发生率更低 根据目前我国房颤抗凝治疗的现状，应着重强调抗凝治疗的疗效和收益，而不是过分的夸大抗凝治疗的风险。 Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks 达比加群降低栓塞发生风险 华法林 达比加群 110 mg BID 达比加群 150 mg BID RR 0.90 (95% CI: 0.74–1.10) P0.001 (NI) P=0.30 (Sup) RR 0.65 (95% CI: 0.52–0.81) P0.001 (NI) P0.001 (Sup) RRR 35% NEJM 2010;363:1875 RE-LY No. at risk: 利伐沙班 6958 6211 5786 5468 4406 3407 2472 1496 634 华法林 7004 6327 5911 5542 4461 3478 2539 1538 655 华法林 HR (95% CI): 0.79 (0.66, 0.96) P（非劣性）: 0.001 天 事件发生率(%) 利伐沙班 利伐沙班 华法林 事件发生率% 1.71 2.16 Am Heart J 2010. 159:340 利伐沙班降低栓塞发生风险ROCKET NEJM 2011 epub 阿派沙班212例，1.27%/年 华法林265例，1.60%/年 P（非劣效性）＜0.001 P（优效性）=0.011 阿派沙班降低栓塞发生风险 ARISTOTLE * Atrial fibrillation (AF) is said to be an epidemic, affecting 1% to 1.5% of the population in the developed world. The prevalence of AF will grow dramatically in the coming decades as the elderly proportion of the population increases. Projected data from the cross-sectional ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) study of 17,974 adults who were enrolled in a large health maintenance organization in California and were diagnosed with AF in 1996-97, have suggested that the number of Americans with AF will increase to more than 5.6 million, (2.5-fold), during the next 50 years [1]. Recent analysis from Mayo Clinic, based on the Poisson estimates of an increase in AF in Olmsted County between 1980 and 2000, has shown that the projected number of adults with AF for the year 2050 could be 12.1 million, assuming no further increase in age-adjusted AF incidence beyond 2000, and 15.9 million (a 3-fold upsurge from 2000), if a continuous raise in the incidence of AF is present [2]. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE,