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2015长城会:张萍教授:从指南看房颤抗凝策略的变迁

2015-11-02 北京清华长庚医院 张萍 中国医学论坛报

第二十六届长城国际心脏病学会议 第九届北京五洲国际心血管病会议2015 亚太心脏大会暨国际心血管病预防与康复会议2015    房颤患者卒中风险升高5倍,无论阵发性、持续性,有症状、无症状的房颤都将显著增加血栓性卒中风险,因此抗凝治疗已成为房颤的基本治疗策略。但在房颤抗凝治疗过程中需要评估卒中风险与获益,同时还需选择适宜的抗凝药物。 缺血性卒中风险评

第二十六届长城国际心脏病学会议

第九届北京五洲国际心血管病会议2015

亚太心脏大会暨国际心血管病预防与康复会议2015   

房颤患者卒中风险升高5倍,无论阵发性、持续性,有症状、无症状的房颤都将显著增加血栓性卒中风险,因此抗凝治疗已成为房颤的基本治疗策略。但在房颤抗凝治疗过程中需要评估卒中风险与获益,同时还需选择适宜的抗凝药物。

缺血性卒中风险评分变迁2006年欧洲心脏病学会(ESC)房颤指南推荐了评估房颤患者发生血栓栓塞风险的CHADS2评分方法:有充血性心力衰竭、高血压、年龄≥75岁和糖尿病各得1分,有卒中、短暂性脑缺血发作(TIA)或栓塞病史加2分,总分6分。2010年指南更新时又提出了CHA2DS2-VASc 评分法:血管疾病、女性、年龄65~74岁各加1分,年龄≥75 岁提升至加2分,总分9分。但2013年美国心脏学会(AHA)、美国心脏病学会(ACC)和美国心律学会(HRS)颁布的房颤管理指南未接受新的评分系统,直到2014年才接受,并指出这一评分系统可更好地识别低风险患者。

抗凝药物推荐不断变化对于非瓣膜性房颤,CHA2DS2-VASc评分为0时,所有指南均不提倡抗栓治疗;对于有卒中史、TIA 或CHA2DS2-VASc 评分≥2 分的患者,新指南推荐既可应用华法林,也可考虑NOACs(包括达比加群、利伐沙班、阿哌沙班),华法林和NOACs的选择是平行推荐,没有先后。为保证抗凝治疗的安全性,2014年的房颤指南推荐了应用华法林时INR值监测的周期以及慢性肾脏功能不全患者的抗凝治疗策略。对于瓣膜性房颤患者推荐应用华法林。对于肥厚型心肌病患者推荐直接应用抗凝治疗,不需CHA2DS2-VASc 评分。对ACS 合并房颤且CHA2DS2-VASc 评分≥2 分的患者,推荐华法林抗凝,由于循证依据不足,没有推荐NOACs。2014 年的房颤管理指南使NOACs的地位提升,抗血小板治疗的地位下降。

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    2015-11-02 fatalmelanie

    及时信息

    0

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    2015-11-02 fatalmelanie

    0

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    2015-11-02 nizongzan

    谢谢啦!

    0

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    2015-11-02 nizongzan

    最新的信息,节省时间了解动态

    0

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    2015-11-02 nizongzan

    学到好多东西

    0

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