对于非瓣膜性房颤使用新型抗凝药物的用量如何确定?

2021-07-23 MedSci原创 MedSci原创

对于非瓣膜性房颤使用新型抗凝药物的用量如何确定?-第七个问题.

《梅斯直播课:心源性卒中诊断评估及治疗策略》

回答问题7:对于非瓣膜性房颤使用新型抗凝药物的用量如何确定?

 

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1635330, encodeId=3c64163533008, content=<a href='/topic/show?id=e23f995430c' target=_blank style='color:#2F92EE;'>#非瓣膜性房颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99543, encryptionId=e23f995430c, topicName=非瓣膜性房颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e8ff22444815, createdName=12498710m18暂无昵称, createdTime=Mon Oct 11 11:03:56 CST 2021, time=2021-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798275, encodeId=f0251e98275f9, content=<a href='/topic/show?id=77d768e77e2' target=_blank style='color:#2F92EE;'>#瓣膜性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68777, encryptionId=77d768e77e2, topicName=瓣膜性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cdcd18, createdName=bshuang, createdTime=Tue Mar 29 12:03:56 CST 2022, time=2022-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1998529, encodeId=30dd1998529bf, content=<a href='/topic/show?id=efbf5822950' target=_blank style='color:#2F92EE;'>#新型抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58229, encryptionId=efbf5822950, topicName=新型抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3609256, createdName=zhu_jun9837, createdTime=Sat May 07 01:03:56 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819492, encodeId=f1f61819492a9, content=<a href='/topic/show?id=3d0099539fd' target=_blank style='color:#2F92EE;'>#非瓣膜性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99539, encryptionId=3d0099539fd, topicName=非瓣膜性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Sat Apr 30 06:03:56 CST 2022, time=2022-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583695, encodeId=10211583695f4, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Jul 25 01:03:56 CST 2021, time=2021-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031437, encodeId=805a103143ef3, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Jul 23 13:03:56 CST 2021, time=2021-07-23, status=1, ipAttribution=)]
    2022-03-29 bshuang
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    2021-07-23 心介

    房颤,临床上碰到很多哦

    0

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由此可见,无论在非瓣膜性房颤相关性缺血性卒中或短暂性脑缺血发作发作后3天内或4天或更短时间内开始DOAC治疗,发生卒中或全身性栓塞、大出血和死亡的风险均相当。

Eur Heart J:非瓣膜性房颤患者持续服用口服抗凝药的预测因子、时间进程和结局

至少四分之一的NVAF患者在4年内未持续使用OAC,这与缺血性卒中预防效果不佳有关。明确这类患者的基线特征可能有助于识别具有非持续性使用OAC风险的患者。

JACC:糖尿病前期也可增加非瓣膜性房颤患者的卒中风险

糖尿病(DM)可增加非瓣膜性心房颤动(NVAF)的栓塞风险,糖尿病前期是否也会增加这类患者的栓塞风险?

Chest:非瓣膜性房颤患者四种口服抗凝血剂的有效性和安全性评估

由此可见,在NVAF亚洲人最大的实践研究中,四个DOAC与华法林相比,血栓栓塞和出血风险较低。即使在高风险亚组中也是一致的。

2019 ESO指南:卒中或短暂性脑缺血发作以及非瓣膜性房颤患者卒中和其他血栓栓塞事件二级预防抗栓治疗

2019年4月,欧洲卒中组织(ESO)发布了卒中或短暂性脑缺血发作以及非瓣膜性房颤患者卒中和其他血栓栓塞事件二级预防抗栓治疗指南,文章主要建议内容涉及药物治疗时间和桥接治疗,左心房封堵术,既往脑出血患者重新开始治疗,特定患者的药物治疗等。

JAHA:血压变异性对非瓣膜性房颤患者不良事件的影响

收缩压变异性与非瓣膜性房颤患者的所有不良事件均显著相关。需要进一步的研究来阐明非瓣膜性房颤患者血压变化与不良预后之间的因果关系。

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JAHA:非瓣膜性房颤患者的常见癌症类型与卒中和出血风险的关系

乳腺癌和前列腺癌与房颤患者卒中风险增加有关,而在某些类型的癌症中,出血的风险似乎超过了卒中的风险。在这些患者中,应仔细评估口服抗凝剂的处方,以平衡出血和卒中的风险。

Neurology:缺血性卒中患者口服抗凝药物时替代抗凝策略与预后的关系

近日,一项发表在Neurology上的研究提供第二类证据,在患有非瓣膜性心室颤动的缺血性卒中患者中,继续使用 DOAC 治疗在预防复发性缺血性卒中方面比转用不同的 DOAC 或华法林更有效。

EuroPCR 2023:接受AnchorMan左心耳封堵系统治疗的非瓣膜性患者术后12个月随访结果显示不劣于WATCHMAN(SAFE PROTECT试验)

房颤患者中风风险比正常人高5倍,20%的中风与房颤有关,房颤中风具有高致残率、高致死率和高复发率的特点。而引起脑卒中的血栓,90%以上甚至100%与左心房内的一囊状样结构——左

国际心律失常专家提醒:房颤发病年轻化,要警惕!

我国目前约有约千万人罹患房颤,是房颤第一患病大国。随着年龄的增长,房颤患病率急剧增高。

Br J Clin Pharmacol:非瓣膜性房颤遇上肝病,直接口服抗凝剂的使用和长期疗效

直接口服抗凝剂(DOACs)被推荐为预防非瓣膜性心房颤动(NVAF)合并卒中患者的一线治疗药物。这些建议是基于大型随机对照试验的临床结果,与维生素K拮抗剂(VKAs)相比,DOACs有类似或更好的疗效

Eur Heart J:非瓣膜性房颤患者持续服用口服抗凝药的预测因子、时间进程和结局

至少四分之一的NVAF患者在4年内未持续使用OAC,这与缺血性卒中预防效果不佳有关。明确这类患者的基线特征可能有助于识别具有非持续性使用OAC风险的患者。