房颤治疗新型抗凝药物进展.ppt

* * Patients with AF and at least one risk factor for stroke ACTIVE A: trial of clopidogrel + ASA vs ASA alone for the prevention of stroke ( in patients unsuitable for oral anticoagulation) In patients with atrial fibrillation for whom vitamin K–antagonist therapy was unsuitable, the addition of clopidogrel to aspirin reduced the risk of major vascular events, especially stroke, and increased the risk of major hemorrhage. ACTIVE W: trial of clopidogrel + ASA vs warfarin for the prevention of stroke the results of ACTIVE W show that anticoagulation is better than dual antiplatelet therapy in the long-term prevention of major ischaemic events (3·9% per year for warfarin and 5·6% for aspirin plus clopidogrel) without an increase in major bleeding (2·2% per year and 9·4% per year, respectively). Thus, after ACTIVE W there is no indication whatsoever to change the current standard of care in high-risk patients with atrial fibrillation. Vascular event: composite of stroke, MI, non-central nervous system systemic embolism , vascular death 房颤患病率与年龄 Feinberg WM. Arch Intern Med. 1995;155(5):469–473 Framingham Study Cardiovascular Health Study Mayo Clinic Study Western Australia Study 发病率 (%) 年龄 (岁) 40 50 60 70 80 90 20 18 16 14 12 10 8 6 4 2 0 ACTIVE 试验中风率与风险降低 Connolly SJ, et al. Lancet 2006; 367:1903. Connolly SJ, et al. N Engl J Med 2009; 360:2066. 治疗 VKA C+A ASA ACTIVE W (年发生率) 1.4 2.4 ~ ACTIVE A (年发生率) ~ 2.4 3.3 RRR versus ASA -58% -28% ~ RRR versus C+A -42% ~ ~ VKA = 口服抗凝剂 C+A = 氯吡格雷 + 阿司匹林 ACTIVE = AF Clopidogrel Trial with Irbesartan for Prevention of Vascular Events. ACTIVE Investigators. Lancet. 2006;367:1903-1912. ACTIVE Investigators. N Engl J Med. 2009;360(20):2066-2078. 房颤-抗血小板治疗 ACTIVE-W:6706 randomized patients;trial stopped 6 4 0 2 Outcome/Year (%) Stroke VascularEvent MajorBleeding 5 3 1 P = .0003 P = .001 P = .53 Warfarin Clopidogrel + ASA ACTIVE-A:7554 randomized patients;median follow-up of 3.6 years