ACC房颤抗凝学术快递ppt课件

1、杨杰孚，北京医院岭南会议之ACC抗凝论坛2019. 4. 12，广州Updates on Guidelines, Glance at Real-world:ACC房颤抗凝领域热点l从临床实验到指南构成：l依托大型临床实验，学会指南延续更新发表l从指南引荐到临床运用：l真实世界数据初步积累:房颤指南接踵发表:Associated Guidelines and StatementsTitleOrganizationYearGuidelinesAssessment of Cardiovascular Risk in AsymptomaticAdultsACCF/AHA2019Atrial Fibri

2、llationCCS2019Atrial FibrillationESC2019Device-Based TherapyACCF/AHA/HRS2019Antithrombotic TherapyACCP2019Valvular Heart DiseaseAHA/ACC2019Atrial FibrillationAHA/ACC/HRS2019StatementsTreatment of Atrial FibrillationAHRQ2019Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial

3、 Fibrillation: a Science Advisory for Healthcare ProfessionalsAHA/ASA2019Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-Up, Definitions, Endpoints, and Research Trial Des

4、ignHRS/EHRA/ECAS20192019 AHA/ACC/HRS Atrial Fibrillation Guideline. Circulation. 2019;129:000000:Mechanisms of AF2019 AHA/ACC/HRS Atrial Fibrillation Guideline. Circulation. 2019;129:000000:Less than 15% of patients are CHA2DS2VASc 0-1:NOAC与华法林：我们根据什么为患者选择抗凝药物？lTo make them feel better/觉得更好lTo avoid

5、 unpleasant events/防止不良事件lTo let them live longer/生存更久:To make them feel better - NOAC:NOAC:To avoid unpleasant events NOACMedical Costs Avoided for Prevention of Stroke with Use of NOACs: Estimates for the Real World ; ACC 14:消化道出血：运用NOAC应留意的重要不良事件荟萃分析包括NOAC全部III期实验New Oral Anticoagulants and Gastr

6、ointestinal Bleeding: Insights from Meta-analyses and Trial Sequential Analyses of Randomized Clinical Trials; ACC 14 :To let them live longer:NOAC：新指南更多引荐: 肾功能不全 高血压 糖尿病 联用抗血小板药物NVAF患者抗凝治疗预防卒中重要危险要素:房颤患者血栓栓塞事件随肾功能下降显著添加:卒中/栓塞风险、主要出血风险与肌酐去除率相关Apostolakis S et al. Eur Heart J 2019;eurheartj.eht328 慢性

7、肾病是NVAF患者卒中预防的重要危险要素Chronic kidney disease is an important risk factor for stroke in NVAF:抗凝治疗针对肾功能调整剂量:NVAF患者抗凝治疗预防卒中应注重血压控制Poorly Controlled Blood Pressure is Independently Associated with a 50% Higher Risk of Stroke or Systemic Embolism in Patients with Atrial Fibrillation: Results from the ARIST

8、OTLE Trial；ACC 14:伴糖尿病NVAF患者运用NOAC获益更大Apixaban Compared with Warfarin in Patients with Diabetes and Nonvalvular Atrial Fibrillation in the ARISTOTLE Trial；ACC14:NVAF患者运用NOAC抗凝预防卒中应防止联用抗血小板药物 Novel Oral Anticoagulants and Antiplatelet Therapy for Stroke Prevention in Atrial Fibrillation: a Meta-analy

9、sis; ACC 14:ACC房颤抗凝领域热点l从临床实验到指南构成：l依托大型临床实验，学会指南延续更新发表l从指南引荐到临床运用：l真实世界数据初步积累:真实世界研讨：临床运用抗凝药物相关要素Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) registry; ACC 14:真实世界研讨：临床运用抗凝药物停药率比较Real World Discontinuation Rates with Apixaban versus Warfarin, Dabigatran or Rivaroxaban among Atrial Fibrillation Patients Newly Initiated on Anticoagulation Therapy: Early Findings; ACC 14:小结AHA/ACC/HRS2019房颤新指南明确采用CHA2DS2-VASC评分指点抗凝积分2为高