新版肺栓塞指南的更新要点课件

新版肺栓塞指南的更新要点研究的核心目的:改善临床实■循证医学研究:随机对照研究■真实世界研究:注册登记研究■转化医学研究:新的靶点或通路——处理更多的临床问题全球范围内肺血栓栓塞症发生率居患病人数显著升高院内病死率下降趋势E至8InodenceRate6一19971999200120032005200720092011201319971999200120032005200920112013)cadence(Rght)Casefatalityrates.Dabs61=6466.68.70)publicationwasincluded."Pulmonaryembolismwaslistedasprincipaldagnosis.tAnyistedcodeforManagementofPulmonaryEmbolismnUpdateJACCVOL.67.NO.8.2016StavrosV.Konstantinides,MD,PtD.StefanoBarco,MD,MareikeLankeit,MD,GuyMeyer,MD优化疑诊肺栓塞的处理策略前瞻性多中心队列研究(YEARSstudyaTheYEARSalgorithm,anovelandsimplifieddiagnosticalgorithmforsuspectedacutepulmonaryembolismhasbeenprospectivelyinvestigatedaTheYEaRSalgorithmconsistsofonlythreeitems■clinicalsignsofdvt■haemoptysisawhetherpulmonaryembolismisthemostlikelydiagnosisSimplifieddiagnosticmanagementofsuspectedpulmonaryOembolism(theYEARSstudy):aprospective,multicentre,cohortstudynderHu!HeinghasHemanHofsteeMarceMCHovensKarinAHKoasjage,RickC)vanKEnk,Maricke).AMaruhuSaskiaMiddeldorpMathideNikeuterLiselotteMvanderPolSuzanneSchd-.MarietenwoldeFrederiksANokMennoHuismLancet.2017Ju15390(10091):289-297新型口服抗凝药物系列研究证据:NOACs治疗VTE的疗效不劣于华法林VTE复发或ⅥTE相关性死亡PValueHR(95%Ci)(non-inferiorityDabigatran1.09(0.76-157)<Rivaroxaban0.89(0.66-1.19)<.001Apixaban°0.84(0.60-1.18)<001Edoxaban'0.89(070-113)<0010.500751001.251.501.75FavorsNOACFavorsWarfarinaSchulmanS,etal.Circulation.2014:129:764-772]:b.PrinsMH,etal.Thromb/.2013:11:218JMed.2013a:369:799-80851:d.Hokusai-VTEInvestigators.NEnglJMed.2013:369:1406-14154新型口服抗凝药物系列研究证据:NOACs抗凝相关大出血风险可能更低抗凝相关大出血风险PValueDabigatran073(0.48-1.11)Rivaroxaban0.54(0.37-0.79)Apixabans0.31(0.17-0.55)001Edoxaban084(059-1.21).3500.25NS=NonspecificFavorsNOAcFavorsWarfarinSchulmanS,etal.Circulation.2014:129:764-7723:b.PrinsMH,etal.Thromb2013:11:216AgnelliG,etal.NEnglJMed.2013a:369:799-8085;d.Hokusai-VTEInvestigators.NEnglJMed.2013:369:1406-14154国人肺栓塞精细化诊疗方案的系列■溶栓抗凝剂量与疗效和安全性研究■肺栓塞预后及相关影响因素的研究■揭示国人VTE的负担和发病风险低剂量rtPA溶栓治疗肺栓塞的疗效和CHESTOrininalReserch获得国际该领域权威学者高度评价EfficacyandSafetyofLowDinge剂量减半,同样疗效,更少出血该研究将改变肺栓塞的临床实践”Chest2010.137:254-262低剂量rtPA与肝素比较降低血栓负荷,减少肺动脉高压不增加出血风险ThrombRes.2014.133:357-363CHEST//o·低剂量rt-PA与标准剂量rtPA比较·保持疗效,大出血发生率显著降低·低剂量溶栓方案在欧美推广应用Chest.2012.141:e4194945EurHeartJ.2014.35143):30333069低剂量rt-PA溶栓方案被ACCP及ESc指南采纳精细化抗凝治疗的安全性与相关危险因素-·真实世界肺栓塞抗凝过程中存在很高的出血发生率Chest2010.137:69s-77s年龄、基础疾