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Atrial fibrillation (AF) is now regarded as the arrhythmia for which patients are hospitalized the most frequently, an arrhythmia that is responsible for significant morbidity and mortality. Of particular importance is that the arrhythmia is associated with a significant incidence of thromboembolism which may induce disabling and incapacitating strokes, sometimes fatal. In the past, it was thought that in patients with AF restoration and maintenance of sinus rhythm prevent the development of strokes, a presumption that has not been vindicated by controlled clinical trials. On the other hand, over many decades, it has been established that appropriate anticoagulation especially with warfarin can reduce stroke rate in nonvalvular AF by about 70%, and mortality by 26%. Aspirin reduces stroke rate by 26%, mortality by about 10%. Thus, in AF oral anticoagulants have become the focal point of therapy for the prevention of strokes and the safety and efficacy of such a therapy has been established by controlled clinical trials; moreover, the subsets of patients with AF in whom anticoagulation is mandatory have been defined on the basis of defined risk factors. Warfarin is now the anticoagulant of choice although its limitations are considerable in terms of drug-drug interactions, narrow range of therapeutic index requiring strict monitoring of intensity of anticoagulation, among other limitations which influence compliance of therapy with the agent. In this review, the continuing role of warfarin in the prevention of stroke in patients with AF is discussed as a background for the development of newer anticoagulants. The issue is of particular importance in the older patients, in whom the development of safer antithrombotic therapies remain a major challenge. In this context, the potential role of the direct thrombin inhibitors hold promise for the future and the evolving data on leading compounds of this class which may be competitive with warfarin are discussed. 相似文献
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Atrial fibrillation (AF) is the most potent common risk factor for ischemic stroke. The number of Americans with nonvalvular AF is expected to increase markedly over the next several decades, making AF-related stroke an important public health concern. Given the individual and societal burden associated with AF-related stroke, efforts to identify and implement efficacious and acceptably safe therapeutic stroke prevention strategies are paramount. This article reviews the existing randomized trial evidence supporting the efficacy of oral vitamin K antagonists (ie, warfarin) or aspirin for preventing thromboembolism in AF, as well as completed and ongoing studies exploring novel antithrombotic agents including the oral direct thrombin inhibitor, ximelagatran, other antiplatelet agents (eg, clopidogrel), factor Xa inhibitors, and other pharmacological agents and additional therapeutic approaches such as mechanical devices and surgical procedures to obliterate the left atrial appendage. 相似文献
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心房颤动已经成为严重威胁老年人健康的慢性疾病,而老年房颤最常见的并发症即为脑卒中及其他血管栓塞事件,其致残率及致死率高。但临床中老年房颤患者抗凝不足,故老年房颤患者抗凝治疗甚为重要。 相似文献
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Nixdorff U 《International journal of cardiology》2005,100(2):191-198
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 2.2 million Americans. The management of non-valvular AF is likely to become even more challenging over the coming decades. The treatment target of AF takes 3 forms: cardioversion, rate control, and minimization of embolic risk. Recently, rate, rather than rhythm control has emerged as a valid therapeutic option in patients with persistent AF. According to current guidelines, International Normalized Ratio-targeted oral anticoagulation and proper stratification of risk remain fundamental principles of management. This article reviews, in depth, the current therapeutic options for atrial fibrillation including oral anticoagulants and unfractionated heparin, as well as reviewing new therapeutic options including bridging therapy with low-molecular-weight heparins and the new oral antithrombotic drug, ximelagatran. 相似文献
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Lopes RD Piccini JP Hylek EM Granger CB Alexander JH 《Journal of thrombosis and thrombolysis》2008,26(3):167-174
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, accounting for approximately one-third of hospitalizations for cardiac rhythm disturbances. The highest incidence of AF is in patients 70-80 years old and other high-risk populations. Although the diagnosis of AF is usually straightforward, effective treatment strategies are less well implemented. This is particularly true for antithrombotic therapy, which is very effective at preventing thromboembolic complications of AF. Stroke is the most significant morbidity in AF patients. The yearly risk of stroke increases from 1.5% for AF patients aged 50-59 to 23% for those aged 80-89. Ischemic strokes secondary to AF carry twice the risk of death when compared with strokes from other causes. We provide a practical and useful review of the most recent American College of Cardiology/American Heart Association/European Society of Cardiology guidelines-based care and future directions of antithrombotic therapy for patients with AF. 相似文献
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Sá SP Rodrigues RP Santos-Antunes J Rocha Gon?alves F Nunes JP 《Revista portuguesa de cardiologia》2011,30(12):905-924
Atrial fibrillation (AF) is an important and potentially modifiable cause of stroke. It has been known since 1989 that oral anticoagulant drugs, such as warfarin, lead to a dramatic decrease in stroke associated with AF. The best risk-benefit ratio is obtained with intensity of oral anticoagulant treatment for an INR of 2-3, even in the elderly. Given the risks of anticoagulant therapy, including bleeding, individual thromboembolic risk must be assessed in patients with AF. In 2009, dabigatran was shown to be a reasonable alternative to vitamin K antagonists, establishing itself as a major alternative to warfarin in AF patients. Rivaroxaban and apixaban have subsequently also been shown to be alternatives to warfarin. When there are contraindications to vitamin K antagonists, antiplatelet agents can produce a therapeutic effect, although much less than oral anticoagulants. Apixaban may be a better alternative to aspirin in this setting. Patients with low-risk atrial fibrillation (no risk factors) have not been the subjects of specific clinical trials. It is unclear what would be the best therapeutic choice for these patients. 相似文献
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Zimetbaum P 《Circulation》2012,125(2):381-389
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Atrial fibrillation significantly raises the risk for ischemic stroke, and the prevalence of atrial fibrillation is increasing
due to the aging of the population. Reducing the risk of ischemic stroke is one of the cornerstones in the medical management
of atrial fibrillation. Oral vitamin K antagonists such as warfarin are highly effective in preventing atrial fibrillation-related
thromboembolism, but can be challenging to manage and are associated with increased bleeding risk. Aspirin therapy has modest
efficacy in reducing stroke risk, but is much less effective than warfarin. To help guide the choice of optimal antithrombotic
therapy, risk stratification for stroke in atrial fibrillation may be helpful, although most elderly patients derive a net
benefit from warfarin. Older patients have higher bleeding rates on warfarin and are at higher risk for intracranial hemorrhage.
Although the risk of intracranial hemorrhage is generally quite low, its occurrence is associated with significant mortality
and disability, and more effective methods to risk stratify patients for intracranial hemorrhage are needed. 相似文献
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Atrial fibrillation (AF) is a common cardiac condition in the elderly population. The primary concern in individuals with AF is the risk of stroke. The management of AF for stroke prevention requires an understanding of the relative risks and benefits of antithrombotic therapy. Numerous randomized clinical trials have improved tremendously our understanding of the relative merits of anticoagulation and aspirin, and indicate that anticoagulation is the appropriate treatment for the majority of individuals with AF. In patients who have contraindications to anticoagulation, aspirin is recommended. 相似文献
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Cardioembolic strokes account for one-sixth of all strokes and are an important potentially preventable cause of morbidity and mortality. Vitamin K antagonists (e.g., warfarin) are effective for the prevention of cardioembolic stroke in patients with atrial fibrillation (AF) and in those with mechanical heart valves but because of their inherent limitations are underutilized and often suboptimally managed. Antiplatelet therapies have been the only alternatives to warfarin for stroke prevention in AF but although they are safer and more convenient they are much less efficacious. The advent of new oral anticoagulant drugs offers the potential to reduce the burden of cardioembolic stroke by providing access to effective, safe, and more convenient therapies. New oral anticoagulants have begun to replace warfarin for stroke prevention in some patients with AF, based on the favorable results of recently completed phase III randomized controlled trials, and provide for the first time an alternative to antiplatelet therapy for patients deemed unsuitable for warfarin. The promise of the new oral anticoagulants in patients with mechanical heart valves is currently being tested in a phase II trial. If efficacy and safety are demonstrated, the new oral anticoagulants will provide an alternative to warfarin for patients with mechanical heart valves and may also lead to increased use of mechanical valves for patients who would not have received them in the past because of the requirement for long term warfarin therapy. 相似文献
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老年人心房颤动血栓栓塞并发症的防治策略 总被引:1,自引:0,他引:1
心房颤动(atrialfibrillation,Af,简称房颤)为临床最常见的持续性心律失常,并随年龄增加其流行率和患病率也不断增加,Af患者大约50%为75岁及以上者。Af易发生缺血性卒中及血栓栓塞并发症,致死与致残,年长也是Af病人卒中的一个强有力的危险因素。并且Af导致卒中的比例随年龄呈指数性增长。另外,Af增加医疗费用,降低老年人的生活质量,缩短寿命。我国由于人口老化,Af病人亦明显增加。因此,老年人的Af不论节律控制或室率控制,如何选择较有效的防治血栓栓塞策略至为重要。 相似文献