共查询到20条相似文献,搜索用时 15 毫秒
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Howard PA Ellerbeck EF Engelman KK Dunn MI 《The American journal of geriatric cardiology》2001,10(3):139-144
The authors examined warfarin use in elderly patients with atrial fibrillation. Medical records were abstracted from a random sample of Medicare beneficiaries with atrial fibrillation who were discharged from Kansas hospitals. Data were analyzed for warfarin and aspirin use and risk factors for stroke or bleeding in patients 65–79 years of age or 80 years and older. Stroke risk factors other than age and atrial fibrillation were seen in 98% of 142 patients less than 80 years of age and 100% of 141 octogenarians. Warfarin use was similar in the younger and older age groups (50% vs. 45%, respectively; p= ns) and was not associated with the number of stroke or bleeding risk factors. Compared to patients less than 80 years of age, octogenarians were less likely to receive aspirin (38% vs. 27%, respectively; p< 0.05). Anticoagulation rates for high-risk patients with atrial fibrillation were low and poorly explained by stroke or bleeding risks. 相似文献
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Jorge Romero Gbolahan Ogunbayo Samy C. Elayi Yousef Darrat Saul A. Rios Juan C. Diaz Isabella Alviz Luis Cerna Mohamed Gabr Elizabeth Chernobelsky Sanghamitra Mohanty Chintan G. Trivedi Domenico G. Della Rocca Andrea Natale Luigi Di Biase 《Journal of cardiovascular electrophysiology》2019,30(12):2686-2693
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非瓣膜病房颤的华法林抗凝治疗研究 总被引:2,自引:0,他引:2
目的:应用华法林对非瓣膜病性心房颤动患者进行抗凝治疗,观察其抗栓疗效和安全性。方法:服用华法林.从3.0mg。1次/d开始.根据血浆凝血酶原时间国际标准化比率(INR)调整华法林剂量.低抗凝强度组患者(46例)INR为1.5~2.1.标准抗凝强度组患者(66例)INR为2.2~3.0.两组均持续服药,随访1~4年.观察有无血栓栓塞事件及出血并发症。结果:低抗凝强度组中有1例发生脑栓塞,当时INR为1.5.栓塞年发生率为2.2%;标准抗凝强度组无栓塞并发症.两组比较差异无显著性(P〉0.05)。服用华法林期间.低抗凝强度组1例肉眼血尿,出血年发生率为2.2%;标准抗凝强度组发生皮肤黏膜出血4例.牙龈出血3例,球结膜出血1例.出血年发生率为12%。当时的INR除3例为〉3.其余均在2.6~3.0之间,未发生严重大出血.低抗凝强度组出血发生率显著低于标准抗凝血组(P〈0.05)。结论:房颤患者华法林抗凝目标INR值在1.5-3.0安全有效。 相似文献
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随着心房颤动机制的不断深入研究及消融技术的不断改进,消融治疗心房颤动的成功率显著提高,已成为主要治疗手段之一。但目前对各消融方法尚未形成共识,本文将较为常见的消融方法做简要介绍。 相似文献
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Currently, there are more therapeutic options available for AF patients with recurrent symptomatic AF episodes. The studies on the role of device therapy for AF have been promising thus far, but they have not achieved any of the goals of AF management. Based on large randomized clinical trials, patients with SSS should receive atrial-based pacing devices. Moderate sized randomized studies have shown minimal benefit of multi-site pacing in AF prevention, even when combined with antiarrhythmic agents. Alternative site pacing such as septal pacing (high or low), however, may be more advantageous, as it achieves similar results in terms of AF reduction with less hardware. The role of ATP in AF prevention is still in its infancy and will need further studies to determine its role in conjunction with antiarrhythmic agents. Furthermore, the role of radiofrequency ablation of pulmonary veins and other sites of AF initiation has been evolving and may be offered to more patients in the future. This approach may be more acceptable to patients and may gain wider acceptance for some groups of AF patients rather than device therapy. In any event, there is still a large role for pacemaker therapy in the management of AF, especially in patients who cannot benefit from curative ablation or surgery procedures, or patients who have failed these procedures, and particularly elderly patients who typically do not undergo these procedures. Based on current understanding, careful selection of pacing sites and pacing algorithms may help in reducing AF episodes in patients receiving devices. 相似文献
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黄守坚 《岭南心血管病杂志》2007,13(1):5-7
心房颤动是成人最常见的心律失常之一。2000年美国心房颤动病人有230万。心房收缩功能的无序影响心脏做功、代谢和病人的生命质量,令卒中的危险性大增。本主要简述目前临床用于心脏复律为窦性的药物、控制过快心室率的药物和抗凝血药.列举其给药方案和不良反应。为临床医生针对病人具体情况合理制定个体化给药方案提供依据。本未涉及对因治疗的药物。鉴于心房颤动有多种病因,如心瓣膜病、心肌缺血或心肌梗死、肺栓塞、高血压、甲状腺功能亢进、充血性心力衰竭、电击伤、电解质紊乱、特发性心肌病、胃肠道出血引起交感神经张力升高和乙醇中毒等。临床医生应在处理心房颤动的同时注意去除引起心房颤动的相关危险因素。[第一段] 相似文献
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目的 探讨80岁及以上非瓣膜性心房颤动(房颤)患者使用不同抗凝强度华法林的安全性.方法 130例老年持续性或永久性房颤患者被随机抽签分为3组:(1)低强度抗凝组国际标准化比率(INR)1.5~2.0;(2)中等强度抗凝组INR 2.1~2.5;(3)阿司匹林组.观察3组的出血事件情况及对肾功能的影响.结果 低强度抗凝组(35例)无致命性出血及严重出血,轻微出血2例(5.7%);中等强度抗凝组(32例)致命性出血及严重出血各1例(3.1%),轻微出血4例(12.5%);阿司匹林组(63例)致命性出血3例(4.8%),严重出血3例(4.8%),轻微出血7例(11.1%).3组总出血率比较,差异有统计学意义(χ2=5.13,P<0.05).低强度抗凝组与中等强度抗凝组对肾功能的影响差异无统计学意义(P>0.05),但两组明显优于阿司匹林组(P<0.05).结论 80岁及以上房颤患者中,华法林抗凝INR值维持在1.5~2.0安全性好,对肾功能影响较阿司匹林轻.Abstract: Objective To investigate the safety of different intensity anticoagulation therapy of warfarin in preventing thromboembolism in octogenarian patients with nonvalvular atrial fibrillation (NVAF). Methods The 130 patients with persistent or permanent NVAF were randomly divided into three groups: low-intensity warfarin group (35 cases, international normalized ratio, INR (1.5-2.0), moderate-intensity warfarin group (32 cases, INR 2.1-2.5) and aspirin control group (63 cases). The rate of hemorrhagic events and the effect on renal function were observed. Results The incidence of hemorrhage was the lowest in low-intensity warfarin group compared to the other groups with slight bleeding in one case. life-threatening bleeding in one case, severe bleeding in one case and slight bleeding in four cases occurred in moderate-intensity warfarin group. Life-threatening bleeding in three cases, severe bleeding in two cases and slight bleeding in six cases occurred in aspirin control group. There were significant differences in bleeding incidence among the three groups (χ2=5.13,P<0.05). The low-intensity warfarin group and moderate-intensity warfarin group were superior to the aspirin control group in the effect on renal function (P<0.05). Conclusions It is safe that the dose of warfarin is maintained at low anticoagulation intensity between INR 1.5 and 2.0 in octogenarians with NVAF. 相似文献
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Papanastasiou Anastasios Kartas Anastasios Samaras Athanasios Vrana Eleni Papazoglou Andreas Moysidis Dimitrios V. Baroutidou Amalia Botis Michail Liampas Evaggelos Vouloagkas Ioannis Mareti Evangelia Karagiannidis Efstratios Karvounis Haralambos Tzikas Apostolos Giannakoulas George 《Journal of thrombosis and thrombolysis》2022,53(4):851-860
Journal of Thrombosis and Thrombolysis - The relationship between oral anticoagulants (OACs) and prognosis in elderly patients with atrial fibrillation (AF) has not been adequately... 相似文献
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OBJECTIVE: To determine whether the risk of falling (with a possible increased chance of subdural hematoma) should influence the choice of antithrombotic therapy in elderly patients with atrial fibrillation. DESIGN: A Markov decision analytic model was used to determine the preferred treatment strategy (no antithrombotic therapy, long-term aspirin use, or long-term warfarin use) for patients with atrial fibrillation who are 65 years of age and older, are at risk for falling, and have no other contraindications to antithrombotic therapy. Input data were obtained by systematic review of MEDLINE. Outcomes were expressed as quality-adjusted life-years. RESULTS: For patients with average risks of stroke and falling, warfarin therapy was associated with 12.90 quality-adjusted life-years per patient; aspirin therapy, 11.17 quality-adjusted life-years; and no antithrombotic therapy, 10.15 quality-adjusted life-years. Sensitivity analysis demonstrated that, regardless of the patients' age or baseline risk of stroke, the risk of falling was not an important factor in determining their optimal antithrombotic therapy. CONCLUSIONS: For elderly patients with atrial fibrillation, the choice of optimal therapy to prevent stroke depends on many clinical factors, especially their baseline risk of stroke. However, patients' propensity to fall is not an important factor in this decision. 相似文献
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Since cases were first reported in 1994, catheter ablation of atrial fibrillation has undergone rapid development and expansion. The procedure began as an attempt to recreate the Maze III operation with a catheter technique. Understanding the contribution of the pulmonary veins to the initiation and maintenance of atrial fibrillation led to dramatic changes in procedural technique. The segmental ostial and the circumferential approaches have emerged as the 2 dominant methods. Efforts continue in academic centers to better understand the pathophysiology of the arrhythmia and to further refine the ablation procedure to improve patient outcomes. 相似文献
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Catheter ablation therapy for atrial fibrillation 总被引:3,自引:0,他引:3
The past several years have witnessed a significant growth in the number of institutions offering catheter ablation for atrial fibrillation (AF). This growth has been a result of a better understanding of pathophysiology of AF and use of instruments and approaches that made catheter ablation of AF a safe and an effective alternative to the drug therapy. The procedure increasingly is becoming a therapy of choice for a select group of symptomatic, drug-refractory patients without structural heart disease, and it is being offered to a rapidly widening patient pool. This article reviews the procedural aspects and clinical evidence supporting this wider use of AF ablation. In addition, new techniques and technologies for AF ablation and new avenues of research in this area are explored. 相似文献