新发房颤的急诊处理.pptVIP

新发房颤的急诊处理;房颤分类;名称;AF发病率;房颤，脑部的潜在威胁;;急性脑栓塞;AF合并脑卒中患者预后;“低危”患者并不真正低危;血管病作为一个独立脑卒中影响因子，在旧的ChADS2 中并没有体现。 AF患者发生中风的概率会在65岁之后会增高，在75岁之后，出现中风的风险甚至会更高，但在CHADS2中，没有体现年龄分级。;;;关于女性作为新的脑卒中危险因素的几点说明;由于CHA2DS2-VASc评分较CHADS2评分纳入血管疾病，年龄（大于65）以及女性等风险因素，更加精细地评估房颤患者中风的风险。 CHA2DS2-VASc评分更加精细，能够辨别那些“真正低风险（truly low-risk）”的患者，避免过度治疗。 由于纳入更多的风险评估因素，在辨别“真正低风险”同时，对于那些“假低风险”的人群， CHA2DS2-VASc能够识别并且提供使用抗血栓治疗的依据。 ;房颤的治疗;It was the aim of this study to determine the efficacy and safety of vitamin K antagonists (VKAs) and acetylsalicylic acid (ASA) in patients with non-valvular atrial fibrillation (AF), with separate analyses according to predicted thromboembolic and bleeding risk. By individual level-linkage of nationwide registries, we identified all patients discharged with non-valvular AF in Denmark (n=132,372). For every patient, the risk of stroke and bleeding was calculated by CHADS?, CHA?DS?-VASc, and HAS-BLED. During follow-up, treatment with VKA and ASA was determined time-dependently. VKA consistently lowered the risk of thromboembolism compared to ASA and no treatment; the combination of VKA+ASA did not yield any additional benefit. In patients at high thromboembolic risk, hazard ratios (95% confidence interval) for thromboembolism were: 1.81 (1.73-1.90), 1.14 (1.06-1.23), and 1.86 (1.78-1.95) for ASA, VKA+ASA, and no treatment, respectively, compared to VKA. The risk of bleeding was increased with VKA, ASA, and VKA+ASA compared to no treatment, the hazard ratios were: 1.0 (VKA; reference), 0.93 (ASA; 0.89-0.97), 1.64 (VKA+ASA; 1.55-1.74), and 0.84 (no treatment; 0.81-0.88), respectively. There was a neutral or positive net clinical benefit (ischaemic stroke vs. intracranial haemorrhage) with VKA alone in patients with a CHADS? score of ≥ 0, and CHA?DS?-VASc score of ≥ 1. This large cohort study confirms the efficacy of VKA and no effect of ASA treatment on the risk of stroke/thromboembolism. Also, the risk of bleeding was increased with both VKA and ASA treatment, but the net