心房颤动的血栓栓塞并发症预防和抗凝治疗

AF的血栓栓塞（简称栓塞）并发症，尤其是脑栓塞是AF致死及致残的最主要原因之一，故栓塞的预防是AF治疗的重要目标。复律并维持窦律可消除由AF所致的栓塞，有条件者应积极争取复律。但仍有较大比率的患者无法复律或维持窦律，仅能以控制心室率的方法作为AF的长期维持治疗。AF时有效控制心室率可明显改善患者的心功能及症状，但并不能消除栓塞并发症的发生。据统计，AF栓塞并发症的年发生率为0．55％～20％不等，概与观察人群、病因及年龄不同有关。通常趋势是随年龄增长，发生率增高，80岁以上的高龄患者，脑卒中发生率可达20％以上…     

心房颤动患者血栓栓塞危险分层与抗凝治疗策略

心房颤动(房颤)是一个严重的临床问题,其血栓栓塞并发症所致脑卒中导致房颤患者高致死、致残率.Framingham研究表明房颤患者脑卒中年发生率平均为5%;50岁～69岁为1.5%,80岁～90岁为23.5%.……     

非风湿性心房颤动血栓栓塞危险性及抗凝治疗研究进展

非风湿性心房颤动血栓栓塞危险性及抗凝治疗研究进展宁波市解放军１１３院陈振云综述中国医学科学院心血管病研究所陈新审校目前已公认风心病尤其是二尖瓣狭窄伴发心房颤动（ＡＦ）时血栓栓塞危险性较高。抗凝治疗能预防栓塞并发症、降低危险性。但对非风湿性ＡＦ并发栓塞...     

口服抗凝药物预防心房颤动患者脑卒中的研究进展

<正>心房颤动是临床常见的心律失常,我国拥有心房颤动患者超过800万。脑卒中是心房颤动的严重并发症,与年龄和血压匹配的对照人群相比,无潜在瓣膜性心脏病的心房颤动患者发生脑卒中可能性是对照人群的5倍以上,有瓣膜性心     

预防心房颤动病人血栓栓塞的新策略

就预防血栓栓塞的新措施一联用抗血小板制剂、抗凝新药ximelagatran和经皮左心耳导管堵闭术作一综述。     

心房颤动患者抗凝的新选择—ximelagatran

华法林是预防心房颤动血栓栓塞的有效药物,但由于药物本身的局限性使其没有充分应用。ximelagatran是一种有前途的口服直接凝血酶抑制剂,将来可能会取代华法林。本文将对华法林抗凝的益处和局限性,ximelagatran的药理学特点、临床试验评价和优势作一综述。     

心房颤动相关性血栓栓塞与炎症

心房颤动是临床上最常见的心律失常之一，常引起血栓栓塞并发症。最近的研究表明，其发病因素除与血流动力学和血液成分异常有关外，还与炎症密切相关。文章就心房颤动相关性血栓栓塞的炎症表现以及炎症指标与血栓栓塞前的高凝状态、临床高危因素、超声心动图异常和有关生化指标之间的关系做了综述。     

低强度抗凝治疗预防心房颤动患者血栓栓塞的临床研究

目的观察不同抗凝强度的华发林对房颤患者血栓栓塞发生的预防效果和安全性。方法将至少有一个栓塞危险因素的房颤患者114例随机分为华发林常规强度抗凝组(52例)和低强度抗凝组(62)两组。观察两组血栓栓塞及出血事件发生率。结果低强度组血栓栓塞发生3例,常规抗凝强度组1例,两组比较无显著性差异。两组病例中出血事件年发生率;常规组为19.2%,低强度组为4.8%,两组比较有显著性差异(P<0.05)。两组85%的出血事件均发生于INR>2.5时。两组病例无1例严重出血发生。结论INR在1.6~2.5之间时相对安全,其血栓栓塞和出血事件发生率低。对于特殊的易出血及栓塞患者,INR应遵循个体化原则。     

心房颤动相关性血栓栓塞与炎症

心房颤动是临床上最常见的心律失常之一,常引起血栓栓塞并发症。最近的研究表明,其发病因素除与血流动力学和血液成分异常有关外,还与炎症密切相关。文章就心房颤动相关性血栓栓塞的炎症表现以及炎症指标与血栓栓塞前的高凝状态、临床高危因素、超声心动图异常和有关生化指标之间的关系做了综述。     

狼疮性肾炎合并血栓栓塞与抗凝治疗

系统性红斑狼疮、特别是狼疮性肾炎患者经常合并各种动、静脉血栓,其发生机制主要与免疫炎症激活内、外源性凝血途径和损伤内皮细胞有关;抗凝治疗可以阻断炎症与凝血间的正性循环,从而不仅可以防治血栓栓塞性疾病,而且可以减轻狼疮性肾炎的肾脏组织炎症反应,减轻,肾脏损害.     

华法林预防瓣膜病伴心房颤动患者血栓栓塞临床研究

目的　观察不同抗凝强度的华法林对瓣膜病伴心房颤动 (房颤 )患者血栓栓塞发生的预防效果和安全性。方法　将确诊为二尖瓣狭窄伴房颤患者 197例分为华法林抗凝强度国际标准化比率 (INR) 2 5～ 3 5(中等强度 ,76例 )和INR1 8～ 2 4(低等强度 ,12 1例 )两组 ,给予抗凝治疗。观察两组血栓栓塞并发症及出血等不良反应的发生率。结果　低等强度组血栓栓塞年发生率为 0 55% ,中等强度组为 0 ,两组比较差异无显著性。两组病例中 96%的不良反应为出血 ,低等强度组出血不良反应的年发生率为 7% ,中等强度组为 16% ,两组比较差异有显著性 (P <0 0 5) ,但两组中无一例为严重出血。其他不良反应为皮疹及消化道症状。结论　华法林抗凝强度INR1 8～ 3 5能明显降低瓣膜病伴房颤患者血栓栓塞的发生率 ,其安全性好。INR1 8～ 2 4时有一定的血栓栓塞危险 ,INR2 5～ 3 5时有一定的严重出血危险性     

心房颤动抗凝治疗进展

心房颤动(房颤)是一种常见的心律失常,在发达国家患病率占总人口的1.5%～2%,国内2003年的调查显示30岁以上人群房颤患病率为0.65%,估计患病人数约420万。房颤不但显著影响患者的生活质量,还引起血栓栓塞、特别是卒中的发生。卒中是房颤的严重并发症之一,资料显示,每6例卒中患者中有1例为房颤所致,未接受抗凝治疗的房     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

目的探讨持续性心房颤动（房颤）患者经导管射频消融术中不同抗凝方案与围术期血栓事件的关系。方法2004年7月至2007年10月连续收治行导管射频消融治疗的持续性房颤145例。所有患者术前均口服华法林抗凝,使国际标准化比率（INR）控制在2．0—3．0至少1个月。消融前停用华法林并用低分子肝素替代抗凝。2004年7月至2006年1月消融的患者（组Ⅰ）64例,完成房间隔穿刺后,静脉给予普通肝素5000U;2006年2月至2007年10月消融的患者（组Ⅱ）81例,完成房间隔穿刺后根据患者体重予以肝素（100U／kg）,两组患者消融术中每小时均追加肝素1000U。消融后行低分子肝素抗凝3d并口服华法林治疗至少3个月。结果组Ⅰ有4例患者于围术期出现血栓形成或血栓栓塞;组Ⅱ1例持续性房颤患者因消融后第3天自行停用华法林出现短暂性脑缺血发作,其余严格抗凝的患者均未出现血栓事件。组Ⅰ与组Ⅱ消融术前后达到抗凝要求的持续性房颤患者血栓事件发生率差异有统计学意义（4／64对0／80,P=0．037）。结论消融中根据患者体重调整抗凝强度可以显著减少持续性房颤患者围术期血栓事件并发症的发生。     

华法林预防心房颤动患者血栓栓塞55例临床观察

临床试验证实华法林能使非瓣膜房颤脑卒中的年发生率从4 5 %下降到1 4% ,且比阿司匹林更有效〔1〕。但仍有相当比例的房颤患者未应用华法林,栓塞并发症的降低仍未令人满意,其主要原因在于应用华法林过程中,存在出血并发症发生率较高以及频繁采血检测抗凝指标影响了患者服药顺应性〔2〕。本文对有血栓栓塞危险的房颤病人应用不同抗凝强度华法林预防房颤患者血栓形成情况进行临床观察。1　资料与方法1 1　研究对象　1999年4月～2 0 0 2年5月在我院住院及门诊就诊的各种器质性心脏病、高血压、糖尿病、心功能不全、缺血性中风等血栓栓塞危险因…     

肺血栓栓塞症的溶栓和抗凝治疗

肺血栓栓塞症（pulmonary thromboembolism,PTE）是肺栓塞（pulmonary embolism,PE）最常见的类型,估计人群年发病率为70/1 000 000[1],急性PTE病情危重常可危及患者的生命,本文复习近期国内外关于PTE诊断和治疗指南,结合笔者的临床实践,重点阐述PTE的溶栓和抗凝治疗方面的若干临床问题,供临床医师参考.     

华法林预防慢性心房颤动病人血栓栓塞的临床研究

血栓栓塞是慢性心房颤动(房颤)的一大并发症,病人往往因此致死、致残.因此,我国每年有数百万病人须抗凝治疗以预防血栓栓塞发生.不同抗凝强度的华法林对慢性房颤病人血栓栓塞发生的预防效果和安全性的研究国内报道较少.我院自2000年以来对慢性房颤病人(心脏瓣膜病、扩张性心肌病所致)给予华法林抗凝治疗,现将结果报道如下.     

心房颤动426例的临床分析

目的分析基层医院心房颤动住院患者临床特点、血栓栓塞和抗凝治疗现状。方法对2000～2004年426例心房颤动住院患者的临床资料进行回顾性分析。结果高血压是最常见的病因，156例（36．62％），风湿性心脏病54例（12．68％）。房颤患者血栓栓塞的发生率为64例（15．02％），其中瓣膜性房颤与非瓣膜性房颤之间差异无显著性；在非瓣膜性房颤中，左房的大小在栓塞组与非栓塞组差异无显著性。接受华法林治疗89例（20．89％）。结论本研究提示房颤的抗凝治疗在基层医院需进一步加强。     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.