老年高龄房颤患者的抗凝治疗策略.pptVIP

4. 老年房颤患者围术期的抗栓治疗 口服华法林治疗的患者围术期处理 手术或有创操作应暂停华法林，非心脏外科手术前停药5 d，术前应使INR1.3，术前紧急情况下如INR1.5可考虑小量应用维生素K11-2mg，使INR正常。 低血栓栓塞风险者，术前可不用肝素桥接，充分止血后当晚或次晨恢复常规剂量华法林。 中高危血栓风险者，建议用肝素桥接治疗，一般术前24小时给予最后一剂低分子肝素，静脉应用普通肝素的患者，术前4h停用。 需要紧急手术和介入治疗时，建议静脉或口服低剂量维生素K1 (2.5-5mg)，输注冰冻血浆或凝血酶原浓缩物能加速逆转华法林的抗凝疗效。 第31页，共31页。 Prevention of stroke in atrial fibrillation September 2007 * The problem of underutilisation of VKAs is greatest in the elderly. As the current slide shows, the percentage of patients eligible for treatemnt who received VKA therapy decreased from 61% in patients aged between 65 and 74 years to 35% in patients aged 85 years or above. Reference: Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Ann Intern Med 1999;131:927-34. Prevention of stroke in atrial fibrillation September 2007 * The problem of underutilisation of VKAs is greatest in the elderly. As the current slide shows, the percentage of patients eligible for treatemnt who received VKA therapy decreased from 61% in patients aged between 65 and 74 years to 35% in patients aged 85 years or above. Reference: Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Ann Intern Med 1999;131:927-34. Increased prevalence of AF with advancing age: the ATRIA and Rotterdam studies The increased risk of AF in men and with ageing can be seen clearly when examining the findings of the ATRIA and Rotterdam studies.1,2 In the California-based ATRIA study, prevalence of AF was assessed in a population of 17,974 adults. The overall prevalence of AF was 1.1% in men compared with 0.8% in women(p0.001); this increased prevalence was seen across all age groups Prevalence also increased from 0.1% amon