房颤危险分层及抗凝治疗研究进展

房颤(AF)是临床常见的心律失常,脑卒中是其主要并发症。临床治疗的重要环节是栓塞预防,而AF患者的栓塞危险分层有助于临床个体化治疗。本文分析权威指南的AF栓塞危险分层标准,综述达比加群酯、利伐沙班和阿哌沙班等新型抗凝药的临床应用研究进展。     

Managing Bleeding in Anticoagulated Patients in the Emergency Care Setting

Background

Orally administered anticoagulants that offer alternatives to warfarin have been developed in recent years and are currently available for reduction of stroke risk in patients with non-valvular atrial fibrillation, the prophylaxis of venous thromboembolism after hip or knee replacement surgery, and the treatment and secondary risk reduction of deep vein thrombosis and pulmonary embolism.

Objectives

This article will provide a brief introduction to these new oral anticoagulants and then review the approaches that can be taken for the emergency management of hemostasis in patients bleeding or at risk for bleeding while receiving warfarin or one of two newer agents, the direct thrombin inhibitor dabigatran or the factor Xa inhibitor rivaroxaban.

Discussion

Oral anticoagulant use is widespread and likely to continue to increase. Warfarin has been the standard of care in oral anticoagulation for many years; its bleeding risks are well known and associated emergency protocols are well established. As newer oral anticoagulants become more widely used, similar procedures will need to be developed. Although there are as yet no specific reversal agents for these newer drugs, recommendations for overdose, emergency hemostasis, and preoperative management are available. Further, while the newer agents do not require routine coagulation monitoring, assays for use in non-routine situations are being explored.

Conclusions

The introduction of alternative oral anticoagulants will require emergency procedures that differ in some respects from those currently in place for warfarin and it will be necessary for Emergency Medicine professionals to become familiar with these procedures. Clinical stabilization of the bleeding or at-risk patient remains the emergency physician’s priority.     

高效液相色谱法检测甲磺酸达比加群酯及有关物质

为了研究甲磺酸达比加群酯的有关物质,本研究合成了7个有关化合物,建立了相关的HPLC检测方法(以XBridge C₁₈为色谱柱,甲醇-0.01 mol/L磷酸二氢钾为流动相梯度洗脱,检测波长为310 nm),并对样品的溶解溶剂和进样体积进行了筛选。结果显示,所建立的HPLC分析方法能使达比加群酯和7个化合物达到完全分离,且重复性好,准确度高,适用于甲磺酸达比加群酯有关物质的检测。     

Carcinoma in Fistula-In-Ano

Whether the increasing incidence of bronchogenic carcinoma is real or apparent has been discussed to a considerable extent in recent years. One important factor in earlier discovery of the disease has been improved technics in roent-genographic diagnosis. Diagnostic procedures and management of bronchogenic carcinoma are presented in a series of illustrative cases, with emphasis on the problems facing the radiologist.     

Atrial fibrillation: an epidemic in the elderly

Atrial fibrillation is the most common cardiac arrhythmia that increases in prevalence with age. As the general population grows older, general practitioners will more frequently see this disease in their clinic population. In order to most effectively treat these patients, physicians need to understand key issues, including the use of rhythm control versus ventricular rate control and how to reduce the risk of ischemic stroke. This article will review recent advancements in the understanding of the pathophysiology, management, stroke risk stratification and prevention of thromboembolic complications in atrial fibrillation.