老年房颤患者抗凝治疗的安全性策略(2018年版).pptVIP

Cumulative survival (%) during the 12-month follow-up of patients with newly diagnosed acute ischemic stroke without (n=6270) and with (n=642) atrial fibrillation Ischemic stroke associated with AF is typically more severe than stroke due to other etiologies This study assessed whether the severity of acute ischemic stroke associated with AF is worse than ischemic stroke associated with other causes A bedridden state was used as an indicator of stroke severity The frequency of bedridden state was 41.2% in stroke patients with AF, compared to 23.7% in patients without AF (P 0.0005) Significantly more Acute Ischemic Stroke patients with AF compared to without were in the bedridden state The odds ratio for bedridden state following ischemic stroke due to AF was 2.23 Reference: Dulli DA, et al. Atrial fibrillation is associated with severe acute ischemic stroke. Neuroepidemiology. 2003;22(2):118-23 * 我国有近800万房颤患者，进行抗栓治疗的不足10%，远低于世界平均水平。在此背景下，中国心脏健康教育联盟（A-A China）与世界同步开展“2014心脏教育周”活动，主题是“关注心房颤，远离脑卒中”，旨在让公众关注房颤脑卒中危险性和抗凝的重要性。6月5日-10日一周，在全国6个省市同步开展。 * 仍然沿用高中低危的危险分层，主要不同是对中高危患者的抗凝管理都给出利伐沙班和达比加群的治疗推荐。 UK: NICE guidance 2006 and 2012 Key priorities for implementation: Antithrombotic therapy In patients with newly diagnosed AF for whom antithrombotic therapy is indicated, such treatment should be initiated with minimal delay after the appropriate management of co-morbidities For patients at intermediate risk: Owing to lack of sufficient clear-cut evidence, treatment may be decided on an individual basis, and the physician must balance the risk and benefits of warfarin versus ASA. As stroke risk factors are cumulative, warfarin may, for example, be used in the presence of 2 or more moderate stroke risk factors This scheme was updated by Lip et al. in 2009 to include newly recognized risk factors such as female gender, and expressed as the cumulative point-based scheme CHA2DS2-VASc2 New NICE recommendations were made on dabigatran in March 2012 and on rivaroxaban in May 201