王冬梅ACS合并房颤患者抗栓治疗策略2014燕赵会课件.ppt

发生卒中的中、高危房颤合并ACS?患者，OAC联合一种抗血小板药物（如氯吡格雷）。对于卒中低危房颤合并ACS?患者，可仅用双联抗血小板药物。 卒中高危的房颤患者PCI?后，短期联合应用阿司匹林、氯吡格雷及OAC。置入BMS?者三联用1?个月，DES?者至少用3-6?个月。此后OAC联合一种抗血小板药物治疗至1?年。1?年以后若无冠状动脉事件可长期单用OAC。 出血高危患者，可选择OAC联合氯吡格雷，置入BMS?者联用1个月，DES?者1?年。 所有患者首先进行评估，对于HAS-BLED评分≥3?分和CHADS2≥2?分应该更多选择BMS，以减少三联抗栓治疗。DES?仅限于在某些临床和（或）解剖学情况下，预期比BMS?具有显著优势时（如长病变、小血管、糖尿病）选用。 2013 抗血小板治疗中国专家共识 ① 房颤卒中、体循环栓塞和死亡风险； ② 支架内血栓导致心梗和死亡风险； ③ 抗栓的出血风险； ④ 长期联合用抗凝和抗血小板治疗，必要时可联用PPI?或H2?受体拮抗剂以减少消化道不良反应。 PCI?后是否应继续抗凝 应权衡以下风险： 2010 年ESC、欧洲心律协会（EHRA）和欧洲经皮心血管介入协会（EAPCI） 围术期无需暂停华法林 AF＋ACS的抗凝抗栓策略 全新的治疗概念——重视疗效净收益 出 血 平衡 ？？？ 血 栓 小 结 卒中高危的房颤患者PCI?后，置入BMS?者三联用1?个月，DES?者至少用3-6?个月。此后OAC联合一种抗血小板药物治疗至1?年，1?年以后若无冠状动脉事件可长期单用OAC。 有限资料表明，PCI术前不中断OAC可有效预防血栓，未增加出血风险，建议采用桡动脉路径 对于接受择期或非紧急手术的患者，INR水平通常为2.0~3.0时，不必额外应用UFH 而对于STEMI患者，不管INR为多少，都应使用适量的UFH（如30~50 U/kg） 建议更多选择BMS，DES?仅限于长病变、小血管、糖尿病 Nonvalvular atrial fibrillation (NVAF) is a common cardiac dysrhythmia affecting over 3 million people in the US, over 4.5 million in Western Europe including France, Germany, Italy, Spain and UK, and over one and a half million in Japan. Reference: Singh BN. Recent advances in the management of atrial fibrillation. Eur Heart J. 2008;10:H2-H3  * * The number of patients with AF is anticipated to increase The elderly now make up a larger proportion of the world population than ever before, and recent estimates suggest that by 2025 there will be 1.2 billion individuals worldwide who are ≥60 years of age1 As a consequence, the projected number of people with AF is anticipated to increase. For example, in the US: As part of the ATRIA study, Go and co-workers (2001) estimated an increase to 5.6 million cases up to 2050 in the US, based on prevalence data from a population of 1.89 million adults 20 years of age enrolled in a large health maintenance organization in California USA2 In another study, Miyasaka et al. (2006) described the trends in age-adjusted incidence of AF in a community in Olmsted County, Minnesota, over a 21-year period (1980–2000), w