老年人抗凝治疗.pptVIP

内容提要 老年患者房颤与卒中的流行病学 老年患者抗凝获益 老年患者出血风险控制 老年患者冠心病合并房颤时联合抗栓及围术期桥接 新型口服抗凝药物 新抗凝药 凝血瀑布 启动 形成 凝血活酶形成 TF/VIIa X IX IXa VIIIa Xa IIa 纤维蛋白原 纤维蛋白 利伐沙班 (Rivaroxaban) 阿哌沙班 （Apixaban) 达比加群酯（Dabigatran） R 非瓣膜性房颤 （至少一项卒中危险因素） 华法林 (INR 2.0-3.0) N=6000 达比加群 110 mg b.i.d. N=6000 达比加群 150 mg b.i.d. N=6000 主要目标：不劣于华法林 平均随访2年（1-3年） 主要终点：卒中+外周栓塞 44个国家 951个中心 达比加群：RE-LY 研究 RE-ＬＹ试验纳入人群 ６个月内房颤有心电图记录的房颤发作 加以下至少一项： 既往卒中/TIA LVEF 40% 3.6个月内NYHA =II 4.年龄至少75 岁或65－74 岁之间加糖尿病，高血压或冠心病 小结 高龄是房颤卒中的危险因素，同时也是出血的独立危险因素，必须重视抗凝前评估 小剂量开始，加强监测INR,注意泌尿生殖道出血 冠心病AF合并抗血小板药物方案尚需大规模循证医学证据 新型抗凝药物无须监测，大出血发生率低，但尚待进一步证据 * New method of predicting stroke in heart patients St. Louis, June 13, 2001 — Researchers at Washington University School of Medicine in St. Louis have developed a formula to predict the risk of stroke in patients with an irregular heart rhythm called atrial fibrillation. “Our hope is that this new classification scheme will help physicians select the appropriate course of treatment for patients with atrial fibrillation,” says Brian F. Gage, M.D., who led the study. Gage is assistant professor of medicine at the School of Medicine and medical director of Barnes-Jewish Hospital’s blood thinner clinic. The results are published in the June 13 issue of the Journal of the American Medical Association. Patients with atrial fibrillation, an irregular, uncoordinated contraction of heart muscles, are estimated to have a fivefold increased risk of stroke. A blood thinner called warfarin sodium (sold as Coumadin? and others) often is used to reduce this risk, but the drug itself can cause hemorrhage and other side effects. It also is more expensive and more difficult to administer and monitor than the alternative treatment, aspirin. To help predict when the benefits of warfarin outweigh the risks, two earlier studies completed by two other research groups determined independent factors that significantly increase the risk of stroke. However, the studies reached somewhat diffe