房颤抗凝幻灯片.ppt

日本华法林使用计量的研究 低剂量华法林（INR维持于1.6～2.6）抗凝治疗，严重出血和颅内出血发生率分别为每人年2.38%和每人年0.60%，显著高于西方人，INR≥2.27是严重出血的独立危险因素之一。 房颤导管消融恢复窦律改善预后 ACTIVE-W 试验为非劣性比较，随机对比房颤患者氯吡格雷75mg，aspl75-100mg（3335例）与华法林（3371例）两种抗栓策略，主要终点为卒中、全身性栓塞心肌梗死或血管性死亡； 试验因主要终点事件华法林明显优于强化抗血小板组提前终止； 结论：尽管华法林存在诸多的不足，该研究仍肯定了可靠疗效。 * 对于不愿意服用华法林或有禁忌的患者，氯吡格雷+阿司匹林 vs 阿司匹林，卒中减少，但出血增多。 Background Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis that the addition of clopidogrel to aspirin would reduce the risk of vascular events in patients with atrial fibrillation. Methods A total of 7554 patients with atrial fibrillation who had an increased risk of stroke and for whom vitamin K–antagonist therapy was unsuitable were randomly assigned to receive clopidogrel (75 mg) or placebo, once daily, in addition to aspirin. The primary outcome was the composite of stroke, myocardial infarction, non–central nervous system systemic embolism, or death from vascular causes. Results At a median of 3.6 years of follow-up, major vascular events had occurred in 832 patients receiving clopidogrel (6.8% per year) and in 924 patients receiving placebo (7.6% per year) (relative risk with clopidogrel, 0.89; 95% confidence interval [CI], 0.81 to 0.98; P = 0.01). The difference was primarily due to a reduction in the rate of stroke with clopidogrel. Stroke occurred in 296 patients receiving clopidogrel (2.4% per year) and 408 patients receiving placebo (3.3% per year) (relative risk, 0.72; 95% CI, 0.62 to 0.83; P0.001). Myocardial infarction occurred in 90 patients receiving clopidogrel (0.7% per year) and in 115 receiving placebo (0.9% per year) (relative risk, 0.78; 95% CI, 0.59 to 1.03; P = 0.08). Major bleeding occurred in 251 patients receiving clopidogrel (2.0% per year) and in 162 patients receiving placebo (1.3% per year) (relative risk, 1.57; 95% CI, 1.29 to 1.92; P0.001). Conclusions In patient