房颤抗凝治疗（E）.ppt

Section16:AnticoagulationfortheLong-termManagementofAtrialFibrillation,TherapyOptionsLong-termManagementofAtrialFibrillation,byStuartJ.ConnollyMDFRCPC,AnticoagulationfortheLong-termManagementofAF,DiscussionPointsReviewtheresultsofthestroke-preventiontrialsinAFDiscusstherisks/benefitsofantithrombotictherapyReviewthecurrentguidelinesforanticoagulationtherapypre-andpost-cardioversion,MultipleThrombiinAF,Halperinetal.Stroke1988;19:937-941.,AFInvestigators:Meta-analysisPatientCharacteristics,Historyof,Study,Mean,age,(y),Inter-,mittent,AF(%),Hyper-,tension,(%),Heart,failure,(%),AFASAK,75,0,31,51,SPAF,66,34,55,19,BAATAF,68,16,51,28,CAFA,67,7,34,20,SPINAF,67,0,58,30,Laupacisetal.Chest1992;102:426S-433S.,0,2,4,6,8,AFASAK58%781,SPAF67%2785,BAATAF86%5196,CAFA42%-6880,SPINAF79%5290,TOTAL68%50?9,Riskreduction,AFInvestigators.ArchInternMed1994;154:1449-1457.Atwoodetal.Herz1993;18:27-38.,StrokeIncidence(%),95%CI,AFInvestigators:Meta-analysisWarfarinforStrokePrevention,p0.03,p0.01,p0.2,p160mmHgDiabetesImpairedLVfunction*IncreasingageWomen75y,*Clinicalheartfailurewithinlast3monthsorfractionalshortening48hours?durationPre-cardioversion:3weeks?anticoagulationPost-cardioversion:4weeks?anticoagulationTargetINR,2.5;range,2?ManageatrialfluttersimilarlytoAF,AmericanCollegeofChestPhysicians,AgeRiskFactors*Recommendation75yAllpatientsWarfarin,*PriorTIA,systemicembolusorstroke,hypertension,poorLVfunction,rheumaticmitral-valvedisease,prostheticheartvalve?TargetINR,2.5(range,2.0?.0),Laupacisetal.Chest1998;114:579S-589S.,AnticoagulationGuidelinesforLong-termAnticoagulation,AmericanCollegeofChestPhysicians,FrequentlyAskedQuestions,1.IsaspirineffectiveforpreventingstrokeinAF?2.WhenshouldapatientwithacuteAFbeanticoagulated?,Answers,AFInvestigators.ArchInternMed1994;154:1449-1457.SPAFInvestigators.Lancet1996;348:633-638.,1.IsaspirineffectiveforpreventingstrokeinAF?Yes.Howevernotaseffectiveaswarfarin.2.WhenshouldapatientwithacuteAFbeanticoagulated?AF48hours:Pre-cardioversion:3weeks?anticoagulationorheparinandTEEPost-cardioversion:3weeks?anticoagulation,CommonMisconceptions,AllpatientswithAFrequireanticoagulation.Stopwarfarininpatientswhohavebeenbackinsinusrhythmfor3monthsandarewellcontr