心房颤动合并急性冠状动脉综合征患者的抗栓治疗研究进展

正国内外指南或共识均已达成共识,心房颤动(atrial fibrillation,AF)患者需口服抗凝药物预防脑卒中等栓塞事件发生,急性冠状动脉综合征(acute coronary syndromes,ACS)尤其经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)后,患者需行抗血小板治疗减少心血管事件的发生。AF合并ACS患者的抗栓治疗难点在于这两类药物不能     

急性冠状动脉综合征合并心房颤动患者抗栓依从性的调查分析

目的调查分析急性冠状动脉综合征合并心房颤动患者抗栓治疗的依从性及其相关因素。方法将接受抗栓治疗的166例急性冠状动脉综合征合并心房颤动患者作为研究对象,所有患者根据CHA2DS2-VASc评分给予相应的抗栓治疗,记录患者基本信息并通过随访调查的形式对患者治疗过程中的抗栓依从性进行统计学分析,并探讨其相关影响因素。结果 166例患者出院后6个月抗栓治疗依从性良好者85例(51.20%),其受患者性别、年龄、文化程度、居住地、是否参加过相关培训及家属认知度有关,组间差异均有统计学意义(P0.05)。166例患者出院后12个月抗栓治疗依从性良好者61例(36.75%),其影响因素可能与年龄、文化程度、居住地、是否参加过培训及家属认知度有关,组间差异存在统计学意义(P0.01)。结论急性冠状动脉综合征合并心房颤动患者院外抗栓治疗依从性低下,其可能影响因素有患者年龄、文化程度、居住地、疾病相关培训及家属认知度。提高患者和家属对疾病及应用药物的认知度能够增加患者院外治疗依从性。     

急性冠状动脉综合征患者应用新型口服抗凝药物仍需更多证据

尽管采取以双联抗血小板等药物治疗为基础的二级预防措施,急性冠状动脉综合征(ACS)患者1年随访时缺血事件复发率仍达10%。研究表明,ACS后凝血系统的持续激活可能是导致残余缺血风险较高的重要环节,因此可以在二级预防中联合口服抗凝治疗。多项评价新型口服抗凝药物(NOAC)对ACS后复发缺血事件预防价值的Ⅱ期和Ⅲ期试验一致显示,联合应用NOAC和抗血小板治疗增加出血风险,但是仅有小剂量利伐沙班显示了疗效获益。     

不同抗凝疗法治疗急性冠状动脉综合征疗效观察

近年来 ,我们分别采用普通肝素和低分子量肝素治疗急性冠状动脉综合征。现将其疗效报告如下。临床资料 :本文 12 8例均为住院患者 ,其中不稳定性心绞痛 88例 ,非 Q波急性心肌梗死 4 0例 ;男 6 8例 ,女 6 0例 ;年龄4 3～ 78岁。入院前 4 8小时内均有典型心绞痛发作。随机分为治疗组与对照组 ,两组患者的性别、年龄、心绞痛病史及伴发心血管危险因素等相似。方法 :治疗组每 12小时皮下注射低分子量肝素 5 0 0 0 IU ;对照组先静注普通肝素 5 0 0 0 IU,继以 75 0 IU/h持续静滴 ,维持 APTT于 6 0～ 80秒 ;两组用药时间均为 7天 ,同时服用肠…     

单中心不同科室住院的心房颤动患者抗凝治疗选择和影响因素分析

目的了解单中心不同科室住院的心房颤动患者的抗凝治疗现状,分析影响抗凝治疗率的主要因素。方法连续入选2017年1～12月于北京清华长庚医院住院的非瓣膜性心房颤动患者共533例,记录CHA_2DS_2-VASc栓塞风险评分、HAS-BLED出血风险评分和口服抗凝治疗情况,通过logistic回归分析影响抗凝治疗的相关因素。结果全部患者中491例(92.1%)CHA_2DS_2-VASc评分≥2,平均抗凝治疗率42.0%;心内科患者的抗凝治疗率高于神经内科、外科和其他内科(54.0%比39.7%、37.3%和24.6%,P<0.001);抗凝药物中,华法林使用比例最高(63.1%),其次是达比加群酯(31.8%)和利伐沙班(5.1%)。多因素logistic回归分析显示,心内科住院(OR:1.509,95%CI:1.281～1.777,P<0.001)、持续性心房颤动(OR:1.795,95%CI:1.234～2.611,P=0.007)、CHA_2DS_2-VASc评分≥2(OR:2.275,95%CI:1.213～4.266,P=0.017)和接受射频消融治疗(OR:2.837,95%CI:1.309～6.148,P=0.002)是心房颤动住院患者接受抗凝治疗的独立预测因素,而HAS-BLED评分>3(OR:0.316,95%CI:0.129～0.775,P=0.007)和合并慢性肾功能不全(OR:0.516,95%CI:0.285～0.936,P=0.010)是其未接受抗凝治疗的独立相关因素。结论本中心不同科室住院的心房颤动患者的抗凝治疗有所不同,总体抗凝治疗率仍然较低,不同科室住院和是否为持续性房颤仍然是影响医生抗凝治疗决策的因素之一。     

心房颤动患者发生急性冠状动脉综合征时抗栓治疗策略

<正>心房颤动(atrial fibrillation)是临床常见的心律失常,在我国患病率约为0.77%~([1])。心房颤动患者由于心房内栓子脱落发生体循环栓塞和缺血性脑卒中的风险远大于正常人群,口服华法林等抗凝药物可以有效降低血栓栓塞和脑卒中的风险~([2-3])。急性冠状动脉综合征(acute coronary syndrome,ACS)患者,使用阿司匹林+氯吡格雷双联抗血小板治疗(dual antiplatelet therapy)可以降低心肌梗死和支架内血栓形成风险~([4-5])。那么对于心房颤动患者发生ACS,理论上应该使用阿司匹林+氯吡格雷+华法林三联抗栓治疗     

心房颤动合并慢性冠状动脉综合征的抗栓治疗进展

心房颤动和慢性冠状动脉综合征常合并存在,二者并存时不仅增加卒中和体循环栓塞风险,且心脏缺血事件风险亦高.对于心房颤动合并慢性冠状动脉综合征患者,采取何种抗栓策略及如何权衡缺血及出血风险是临床上亟待明确的问题.近年来针对抗栓治疗的研究越来越多,现结合最新研究证据就心房颤动合并慢性冠状动脉综合征的抗栓治疗做一综述.     

急性冠状动脉综合征抗凝治疗的获益与瓶颈及亟待优化的问题

<正>冠状动脉斑块形成、破裂和血栓形成是急性冠状动脉综合征(acute coronary syndrome,ACS)缺血事件发生的关键机制。抗凝和抗血小板治疗是ACS药物治疗的基石~([1-3])。目前,欧美及中国指南均推荐,ACS急性期和经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中应给予抗凝治疗     

冠心病合并心房颤动患者抗凝治疗方案的选择

由于冠心病病情的多变性、复杂性以及治疗方式的多样性,加之心房颤动(房颤)的卒中风险、患者的出血风险均因人而异,冠心痛合并房颤的抗凝策略较为复杂,需要进一步细化为各种不同的临床情况予以分别对待,可能涉及一至多重抗凝方案.本文结合两项最新发布的房颤治疗指南(2010年欧洲心脏病学会房颤指南及美国心脏病学会基金会/美国心脏协会房颤指南)、一项2009年欧洲心脏病学会关于房颤伴急性冠脉综合征的抗栓治疗专家共识及新近的相关临床试验结果分别阐述各种冠心病情况合并房颤时的抗凝治疗原则.     

心房颤动患者的抗凝治疗

心房颤动临床常见，现就其抗血凝治疗简要回顾如下。     

社区老年非瓣膜性心房颤动患者的抗凝治疗现状

目的:探讨社区老年非瓣膜性心房颤动(房颤)患者抗凝治疗现状。方法:采用整群抽样方法,抽取上海市长宁区3个社区中年龄≥65岁的常住居民,入选通过心电图或24 h动态心电图及心脏超声检查确诊为非瓣膜性房颤的患者(n=218),对所有患者进行统一问卷调查,包括基本情况、疾病史以及用药情况,并计算CHADS2评分。结果:入选患者中,卒中高危患者(CHADS2评分≥2)有167例,实际接受抗凝治疗的仅23例(13.8%)。对未抗凝治疗原因分析显示,医生未实施抗凝治疗高达63.2%,是抗凝治疗率低的主要原因。结论:社区老年非瓣膜病房颤卒中高危患者抗凝治疗率低,需规范房颤抗凝治疗。     

Oral anticoagulant therapy in patients with atrial fibrillation

In the absence of contraindications, patients with atrial fibrillation and at least one major risk factor for stroke should receive long-term oral anticoagulant treatment to prevent atrial thrombus formation. Because age of more than 75 years is a major risk factor for stroke, but is also a risk factor for major bleeding, the decision to treat elderly patients with anticoagulants should be made on an individual basis.     

Situation of antithrombotic therapy in elderly patients with atrial fibrillation and acute coronary syndrome

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients(more than 60 years old) with non-valvular atrial fibrillation(NVAF) and acute coronary syndrome(ACS) / percutaneous coronary intervention(PCI).Methods This study enrolled 381 elderly patients [mean age(69.95 ± 8.41) years; 289 males, 92 females]with NVAF and ACS / PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups: triple therapy(TT) group, dual antiplatelet therapy(DAT) group,vitamin K antagonist(VKA) plus single antiplatelet therapy(SAT) group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients(9.97%) received TT and 300 patients(78.74%) received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2-VASc≥2 and HAS-BLED 3. Conclusions Elderly patients who suffered NVAF and ACS / PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT.     

Current status of anticoagulation therapy for elderly atrial fibrillation patients in Japan: from Hokuriku atrial fibrillation trial

BACKGROUND: The number of the elderly patients with atrial fibrillation (AF) is increasing, but the current status of anticoagulation therapy for elderly patients with AF in Japan is not clear. METHODS AND RESULTS: Among the patients registered in the "Hokuriku Atrial Fibrillation Trial (HAT) 1", 365 AF patients aged > or =65 years were enrolled in this study. Warfarin was used for significantly less patients in the oldest group aged > or =85 years (36%) than in younger populations, but the percentage of antiplatelet use in this oldest population was largest (40%). The elderly group (> or =85 years) was compared with a younger group aged between 75 and 84 years. Warfarin was given to 61% of the younger group compared with 36% in the elderly group. In the younger group, the more thromboembolic risks they had according to CHADS2 score, the more warfarin was used, whereas there was no clear trend in the usage of warfarin in the elderly group. CONCLUSIONS: The number of elderly Japanese patients with AF taking warfarin is currently low, but because the population of elderly AF patients will increase in the future, there is a need for safe and suitable anticoagulation therapy for elderly patients.     

Physicians' attitudes toward anticoagulant therapy in patients with chronic atrial fibrillation

INTRODUCTION: Although many clinical trials have demonstrated that anticoagulant therapy substantially reduces the risk of ischemic stroke in patients with atrial fibrillation (AF), some physicians are reluctant to use anticoagulants. We investigated attitudes of physicians in Japan toward anticoagulant therapy in chronic AF patients. METHODS: We conducted a survey at the annual meeting of the Japanese Society of General Medicine. We presented subject physicians with 8 vignettes of chronic AF patients and requested that they indicate their most favored choice of therapy from among 6 strategies including warfarin and aspirin. RESULTS: We distributed 209 questionnaires and received 139 replies (67% response rate). For all 8 vignettes presented, only 26% of the respondents preferred to use anticoagulant therapy in AF patients. Longer clinical experiences and responsibility at a teaching hospital were associated with negative attitude toward anticoagulant therapy, while experience of preventive therapy in patients with thromboembolism due to AF and strong influence of clinical trials of anticoagulant prophylaxis on their practice were associated with positive attitude toward the therapy. Among patient characteristics in the vignettes, a risk of thromboembolism was positively associated with preference for anticoagulant therapy, but an advanced age and a risk of bleeding complications were negatively associated with the preference for the therapy. CONCLUSIONS: The physicians in Japan in this survey, especially those with longer clinical experiences or responsibility at a teaching hospital, have a negative attitude toward anticoagulant therapy in chronic AF patients. An advanced age and a risk of bleeding complications of patients are deterrent factors to the use of anticoagulant therapy.     

心房颤动抗凝治疗现状

心房颤动（房颤）是十分常见的心律失常疾病,其发病率与年龄密切相关,在〈50岁的人群中房颤患者罕见,60岁后发病率明显增加,至80岁其发病率接近10%。房颤发病的中位年龄为72岁,男性高于女性。我国首项大规模人群流行病学研究在全国13个省、14个自然人群中抽样29079人,发现中国人房颤患病率约为0．77％,80岁以上人群患病率达7．5％,患者人数接近800万。随着风湿瓣膜性心脏病逐渐减少,非瓣膜性房颤成为目前的主要问题。