课件：房颤的药物治疗及进展.ppt

* * Warfarin is more effective than ‘Aspirin’ at reducing the risk of stroke VKAs are currently the therapy of choice in patients with a medium–high risk of stroke, as reflected in the ACC/AHA/ESC and ACCP guidelines.1 A meta-analysis of 16 trials was conducted to assess the efficacy and safety of antithrombotic therapy for the prevention of stroke in AF.2 Of these 16 trials, warfarin was used exclusively in ten. In six of the trials, which involved 2,900 patients, warfarin dramatically reduced the relative risk of stroke by 62% compared with placebo (one trial allowed the use of ‘Aspirin’ in the placebo group) and provided an absolute risk reduction of 2.7% per year for primary prevention and 8.4% per year for secondary prevention. There was also a relative risk reduction of 26% in all-cause mortality.2 AFASAK, Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Therapy Study BAATAF, Boston Area Anticoagulation Trial for Atrial Fibrillation CAFA, Canadian Atrial Fibrillation Anticoagulation trial EAFT, European Atrial Fibrillation Trial SPAF, Stroke Prevention in Atrial Fibrillation study SPINAF, Stroke Prevention In Nonrheumatic Atrial Fibrillation REFERENCES Fuster V, Ryden LE, Cannom DS et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary. Circulation. 2006;114:700–752. Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 1999;131:492–501. * * Warfarin reduces relative risk of stroke compared with ASA In a meta-analysis of five trials comparing warfarin with ‘Aspirin’, which enrolled 2,837 patients with AF, warfarin reduced the relative risk of all stroke by 36% and the relative risk of ischaemic stroke by 46% compared with ‘Aspirin’.1 While ‘Aspirin’ is effective at preventing less severe, non-disabling stroke it is less effective at providing protection from disabling stroke.2 Despite it