波士顿区有关房颤的抗凝研究(BAATAF)

小剂量华法令对非风湿性房颤患者并发卒中危险性的影响。     

影响房颤抗凝治疗的有关因素探讨

心房颤动（房颤）是脑卒中的独立危险因素。华法林抗凝治疗可使国际标准化比值（INR）控制在2．0～3．0，使房颤患者卒中风险明显降低，但目前仍只有少数房颤患者接受抗凝治疗，有研究显示房颤患者是否接受抗凝治疗受年龄临床并存疾病、出血风险、治疗策略（节律控制或心率控制）等因素的影响。本文回顾性调查305例房颤患者抗凝治疗状况并分析其预测因素，为房颤抗凝治疗提供进一步的临床资料。     

中国房颤抗凝的现状与未来

心房颤动（房颤）是临床上最常见的心律失常,是卒中的独立危险因素。房颤患者心房血流减慢,易产生涡流,凝血物质在左心耳聚集形成静脉样血栓,血栓脱落后随血流到脑部,形成缺血性卒中。与非房颤患者相比,房颤患者卒中的发生风险增高5倍。15％～20％的卒中由房颤导致,而房颤患者卒中年发生率为3％～4％。房颤所致的卒中危害严重,其在1年内增加死亡率和致残率近1倍,复发风险更是增加4．7倍。     

舟山地区老年房颤患者抗凝治疗现状分析

为了解舟山地区老年房颤患者的抗凝治疗现状.我们对2001年1月至2004年9月期间在我院住院就诊的242例老年房颤患者进行了回顾性总结,现报告如下:     

肝硬化合并房颤的抗凝治疗进展

近年来相关研究显示, 在肝硬化患者中, 房颤的发生率明显增高, 心房颤动是慢性、长期抗凝治疗最常见的适应证, 抗凝治疗对降低缺血性卒中的发生有明确作用。肝硬化合并房颤患者抗凝治疗时, 由于肝硬化凝血功能障碍, 其出血及栓塞风险明显增高。同时此类患者在使用目前批准的抗凝药物时, 均会经肝脏不同程度地代谢与消除。使得抗凝治疗更加复杂。现对肝硬化合并房颤患者抗凝治疗风险与获益的临床研究进行总结, 以期为此类患者抗凝治疗提供参考。     

房颤与抗凝治疗

房颤是一种常见的心律失常，该病患者易并发脑血管及体循环血栓栓塞。本文总结七组大样本房颤抗凝治疗的效果及副作用并从其流行病学及自然转归来探讨抗凝治疗的很必要性。     

老年非瓣膜病性房颤华法林抗凝治疗临床分析

随着人口的老龄化,房颤发生率逐年上升,心房颤动对临床的主要危害是增加血栓栓塞的危险.脑栓塞及周围动脉栓塞是心房颤动最常见的并发症,具有一定的致残率和死亡率.因此加强房颤病人血栓栓塞的预防具有一定的临床价值.本文通过对老年非瓣膜病性房颤患者抗凝治疗的观察,探讨老年非瓣膜病性房颤患者用华法林长期抗凝的有效性和安全性.     

心房颤动抗凝治疗的重要性

心房颤动 (房颤 )是临床上最常见的持续性快速心律失常 ,发生率随年龄而增加。房颤患者的病死率是无房颤者的两倍 ,缺血性脑卒中是病死率增加的最主要原因 ,房颤使缺血性脑卒中危险性增加近 5倍。因此 ,对房颤患者 ,尤其是高龄或合并其它脑卒中危险因素者 ,预防缺血性脑卒中的发生显得尤为重要。2 0世纪 80年代后期至 90年代初 ,国外相继开始了大规模、随机对照的临床试验 ,以评估华法林抗凝治疗预防房颤患者发生缺血性脑卒中的疗效。 5个临床试验 (ＡＦＡＳＡＫ、ＳＰＡＦ、ＢＡＡＴＡＦ、ＳＰＩＮＡＦ、ＣＡＦＡ)的荟萃分析结果显示 ,发生…     

老年人心房颤动的抗凝治疗

心房颤动 (房颤 )是老年人最常见的慢性心律失常之一。高龄是房颤的重要危险因素。Ｆｒａｍｉｎｇｈａｍ研究对 5184人随访 30年 ,发现 60岁以上人群约 3%～ 5%有房颤。房颤的发病率随年龄增长而增高 ,50～ 59岁为 0 5% ;60～ 69岁为1 8% ;70～ 79岁为 4 8% ;80 %～89 %为 8 8%。从 17世纪即发现房颤与脑卒中的关系。房颤病人每年脑血管事件的发生率为 4 %～ 6%。随年龄增长 ,由房颤所致脑卒中在所有脑卒中当中所占的比率增高 ,50～ 59岁占 6 7% ,60～ 69岁占 8 1% ,70～ 79岁占 2 1 3% ,80～ 89岁占36 2 %。我国 1999年人口变动情况抽样…     

CAFA:加拿大心房纤颤抗凝试验

作　　者　 (a)ConnollySJ ,LaupacisA ,GentM ,RobertsR ,CaimsJA ,JoynerC ,etal(b)LaupacisA ,SullivanK标　　题　 (a)加拿大心房纤颤抗凝 (CAFA)试验(b)加拿大心房纤颤抗凝试验 :病人须继以华法林治疗吗 ?参考文献　 (a)JAmCollCardiol,1991,18:349～ 35 5(b)CanMedAssocJ ,1996 ,15 4 :16 6 9～ 16 74　　疾　　病　心房纤颤 (非风湿性 )。目　　的　评估华法林在非瓣膜病性心房纤颤减少卒中和其他部位栓塞的效果。研究设计　随机、双盲、安慰剂对照。随　　访　最长 2 75年 ,试验终点后邮访 2 1个月。病　　人　 378例…     

心房颤动患者的抗凝治疗

心房颤动是临床实践中最常见且危害严重的心律失常,是缺血性脑卒中的最主要危险因素之一。有效的抗凝治疗可显著降低心房颤动患者缺血性脑卒中的发生率,成为心房颤动患者治疗策略的重中之重。新型口服抗凝剂为心房颤动患者的抗凝治疗提供了更多选择。现结合近年发表的相关文献对心房颤动患者的抗凝治疗进行综述。     

Trials of Newer Approaches to Anticoagulation in Atrial Fibrillation

Atrial fibrillation comprises a large and growing epidemic in the aging population. Stroke is the most feared complication of atrial fibrillation, and the risk of stroke increases markedly with age. Multiple clinical trials have proven that warfarin anticoagulation is effective in reducing this risk. However, the complex pharmacokinetics and narrow therapeutic window of warfarin make its use in clinical practice challenging. Novel approaches to anticoagulation, including more potent antiplatelet agents and direct thrombin inhibitors, are currently undergoing clinical trials. In addition, nonpharmacological approaches to stroke prevention in atrial fibrillation are also in development. These newer approaches may revolutionize the treatment of this common disorder.     

Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Dialysis

BackgroundPatients on long-term dialysis are at increased risk of bleeding. Although oral anticoagulants (OACs) are recommended for atrial fibrillation (AF) to reduce the risk of stroke, randomized trials have excluded these populations. As such, the net clinical benefit of OACs among patients on dialysis is unknown.ObjectivesThis study aimed to investigate the efficacy and safety of OACs in patients with AF on long-term dialysis.MethodsMEDLINE and EMBASE were searched through June 10, 2019, for studies that investigated the efficacy and safety of different OAC strategies in patients with AF on long-term dialysis. The efficacy outcomes were ischemic stroke and/or systemic thromboembolism, all-cause mortality, and the safety outcome was major bleeding.ResultsThis study identified 16 eligible observational studies (N = 71,877) regarding patients on long-term dialysis who had AF. Only 2 of 16 studies investigated direct OACs. Outcomes for dabigatran and rivaroxaban were limited to major bleeding events. Compared with no anticoagulants, apixaban and warfarin were not associated with a significant decrease in stroke and/or systemic thromboembolism (apixaban 5 mg, hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.30 to 1.17; apixaban 2.5 mg, HR: 1.00; 95% CI: 0.52 to 1.93; warfarin, HR: 0.91; 95% CI: 0.72 to 1.16). Apixaban 5 mg was associated with a significantly lower risk of mortality (vs. warfarin, HR: 0.65; 95% CI: 0.45 to 0.93; vs. apixaban 2.5 mg, HR: 0.62; 95% CI: 0.42 to 0.90; vs. no anticoagulant, HR: 0.61; 95% CI: 0.41 to 0.90). Warfarin was associated with a significantly higher risk of major bleeding than apixaban 5 min/2.5 mg and no anticoagulant (vs. apixaban 5 mg, HR: 1.41; 95% CI: 1.07 to 1.88; vs. apixaban 2.5 mg, HR: 1.40; 95% CI: 1.07 to 1.82; vs. no anticoagulant, HR: 1.31; 95% CI: 1.15 to 1.50). Dabigatran and rivaroxaban were also associated with significantly higher risk of major bleeding than apixaban and no anticoagulant.ConclusionsThis meta-analysis showed that OACs were not associated with a reduced risk of thromboembolism in patients with AF on long-term dialysis. Warfarin, dabigatran, and rivaroxaban were associated with significantly higher bleeding risk compared with apixaban and no anticoagulant. The benefit-to-risk ratio of OACs in patients with AF on long-term dialysis warrants validation in randomized clinical trials.     

The impact of long-term warfarin therapy on quality of life. Evidence from a randomized trial. Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators

To determine the effect of long-term warfarin sodium therapy on quality of life, we surveyed 333 patients participating in a randomized, controlled trial of warfarin for the prevention of stroke in nonrheumatic atrial fibrillation. No significant differences between warfarin-treated and control patients were found on well-validated measures of functional status, well-being, and health perceptions. For example, the summary score for health perceptions was 68.8 in the warfarin-treated vs 66.6 in the control group (scale of 0 to 100; 95% confidence intervals for the difference, -1.6 to 6.0). In contrast, patients taking warfarin who had a bleeding episode had a significant decrease in health perceptions (-11.9; 95% confidence interval, -4.1 to -19.6). Warfarin therapy is not usually associated with a significant decrease in perceived health, unless a bleeding episode has occurred. Negative effects of warfarin treatment on health perceptions may be balanced by confidence in its protective effects.     

Anticoagulation for Mechanical Heart Valves in Patients with and without Atrial Fibrillation

Surgical replacement of a native valve with a biological or mechanical prosthesis is the definitive treatment for many forms of advanced valvular heart disease. Mechanical heart valves are less prone to structural deterioration compared with bioprostheses, but require chronic oral anticoagulation to prevent thromboembolic events. Thromboembolic risk varies based on patient-related risk factors, including atrial fibrillation, advanced age, low ejection fraction, and hypercoagulability. Other important correlates of high thromboembolic risk include valve design, valve position, anticoagulation variability, and time from surgery. Clinical management is further complicated when antithrombotics may need to be interrupted or altered during surgery or pregnancy. At present, vitamin K antagonists are the only approved agents for thromboprophylaxis but are limited because of a narrow therapeutic window and requirement for frequent monitoring. Novel anticoagulants, including inhibitors of factor IIa and Xa, are currently being evaluated and may emerge as alternatives to vitamin K antagonists.