心房颤动的治疗 新的循证医学证据.ppt

ManagementofAtrialFibrillation：UpdateintheEBMproofChangShengMaDepartmentofCardiology,BeijingAnzhenHospitalCapitalMedicalUniversity,P.R.China

PrevalenceofAFisincreasingAdultswithAFib(millions)Year2.082.262.442.662.943.333.804.784.345.165.425.61%363753YearProportionAged?80YrGo:JAMA,2001：2370

Miyasaka.Circulation.2006:119Year2.04.06.08.010.012.014.016.020002005201020152020202520302035204020452050AdultswithAFib(millions)5.110.28.412.115.9PrevalenceofAFisincreasing

Prevalence%AgePrevalenceofAF:theRotterdamstudyHeerinaga.EurHeartJ,2006,9496808pts.,F/U6.9yrs，prevalence5.5%

Incidence‰AgeIncidenceofAF:theRotterdamstudyHeerinaga.EurHeartJ,2006,9496808pts.,F/U6.9yrs，Incidence9.9‰

IdentifiedAF：thetipoftheiceberg14802ptsaged65orover，randomizedtosystemicscreeningandopportunisticscreeningSystemicscreeninggroup:9866pts.Opportunisticscreeninggroup:4936pts.F/U12monsRateofnewAFcaseinsystemicscreening1.63%，RateofnewAFcaseinopportunisticscreening1.04%Fitzmaurice.BMJ.2007,383

RiskforstrokeincreasedinloneAFJahangir.Circulation.2007:3050

Meta-analysis:antithrombotictherapyofAFHart.AnnInternMed,2007,857trialptsRRreduced(%)WarfarinvsPlacebo6290064ASAvsPlacebo8487622WarfarinvsASA121296339

Realworldofwarfarinintheelderly13.1%4.7%Thefirst90daysassociatedwithmajorhemorrhage21%ptswithdrawnwarfarinforsafetyissueThehigherriskofstroke,thehigherincidenceofmajorhemorrhageHylek.Circulation.2007,2689

HRforICHwas4.06forAsiansAsianswereatgreaterriskforwarfarin-ralatedICHShen.JACC.2007:309

Prospective，randomize，control973pts?75yearsoldwithAFRandomizedintowarfarinarm(INR2.0-3.0)andAspirinarm(75mg/d)MeanF/U2.7yrsPrimaryoutcome：fatalordisablingstroke,intracranialhaemorrhage,orarterialembolismWarfarinversusaspirinforstrokepreventionintheelderlywithAF(TheBirminghamAtrialFibri