房颤的治疗方案.pptVIP

2021/1/12 心房颤抖的治疗-抗凝 2021/1/12 风险评估〔ESC房颤指南〕 非瓣膜病房颤的血栓栓塞风险评估 CHA2DS2-VASc 出血风险评估 HAS-BLED 2021/1/12 血栓栓塞风险评估CHA2DS2-VASc (a)Risk factors for stroke and thrombo-embolism in non-valvular AF ‘Major’ risk factors ‘Clinically relevant non-major’ risk factors Heart failure or moderate to severe LV systolic dysfunction Hypertension Age 75 years Diabetes mellitus Previous stroke, TIA, or systemic embolism Vascular diseasea Age 65–74 years Female sex (b) Risk factor-based approach expressed as a point based scoring system, with the acronym CHA2DS2-VASc (Note: maximum score is 10 since age may contribute 0, 1, or 2 points) 2021/1/12 血栓栓塞风险评估CHA2DS2-VASc  Risk factors Scors Congestive heart failure/LV dysfunction 1 Hypertension 1 Age 75 2 Diabetes mellitus 1 Stroke/TIA/thrombo-embolism 2 Vascular diseasea 1 Age 65–74 1 Sex category (i.e. female sex) 1 Maximum score 9 2021/1/12 血栓栓塞风险评估CHA2DS2-VASc  Risk category CHA2DS2-VASc score Recommended antithrombotic therapy One ‘major’ risk factor or 2 ‘clinically relevant non-major’ risk factors 2 OAC One ‘clinically relevant non-major’ risk factor 1 Either OAC or aspirin 75–325 mg daily. Preferred: OAC rather than aspirin No risk factors 0 Either aspirin 75– 325 mg daily or no antithrombotic therapy. Preferred: no antithrombotic therapy rather than aspirin. 2021/1/12 出血风险评估HAS-BLED Letter Clinical characteristica Points awarded H Hypertension 1 A Abnormal renal and liver function (1 point each) 1or2 S Stroke 1 B Bleeding 1 L Labile INRs 1 E Elderly (e.g. age 65 years 1 D Drugs or alcohol (1 point each) 1or2 Maximum 9 points 2021/1/12 2021/1/12 华法林的应用 华法林通过减少凝血因子II、VII、IX与X的合成等环节发挥抗凝作用。只有所有依赖于维生素K的凝血因子全部被抑制后才能发挥充分的抗凝作用，因此华法林的最大疗效多于连续服药4-5天后到达，停药5-7天后其抗凝作用才完全消失。 2021/1/12 华法林的应用 美国等指南推荐华法林的起始治疗剂量为5mg/d-10mg/d，但由于种族和体重差异，我国人群应用华法林治疗时从较低剂量〔如〕开场。初始剂量治疗INR不达标时，可按照的幅度逐渐递增并连续检测INR，直至其到达目的值〔之间；老年患者之间〕。特殊人群〔如老年人、体质虚弱、营养不良、心力衰竭、肝脏疾病、近期曾进展手术治疗、或正在服用可增强华法林作用的药物者〕应从更低剂量〔如〕开场用药。 INR的监测频度应视患者详细情况而定。应用华法林治