冠心病合并房颤的抗栓策略VIP免费

冠心病合并房颤的抗栓策略冠心病合并房颤的抗栓策略冠心病合并房颤患者的流行病学冠心病合并房颤患者的流行病学PublicationResultZoni-BerissoM,etal.ClinEpidemiol.2014;16:213-220房颤患者中，合并冠心病的比例为14%-32%AkaoM,etal.JCardiol.2013;61:260-266房颤患者中，合并冠心病和心肌梗死的比例分别为15.0%和6.4%ChiangCE,etal.CircArrhythmElectrophysiol.2012;5:632-639阵发性、持续性和永久性房颤患者中，合并冠心病的比例分别为30.0%、32.9%和34.3%LopesRD,etal.Heart.2008;94:867-973STEMI和NSTE-ACS患者中，合并房颤的比例为7.5%RathoreSS,etal.Circulation.2000;101(9):969-974急性心肌梗死患者中，合并房颤的比例为22.1%房颤与冠心病密切相关冠心病VS房颤冠心病是房颤的常见病因之一ACS合并房颤增加死亡率GISSI-3研究和GUSTO研究显示，ACS合并房颤增加短期、长期死亡率约20%、34%，新发房颤预后更差ACS合并房颤提示预后不良房颤多见于大面积心肌梗死、前壁心梗、心衰等，提示预后不良123冠心病冠心病抗血小板治疗抗血小板治疗降低降低心血管事件心血管事件心房颤动心房颤动抗凝治疗抗凝治疗减少减少血栓栓塞事件血栓栓塞事件疗效风险抗栓需求抗栓需求VSVS出血风险出血风险血浆因素为主(如凝血因子)细胞因素为主(如血小板)血栓栓塞并发症•卒中•其他系统栓塞动脉粥样硬化血栓形成•再发缺血事件•支架内血栓形成出血事件长期抗凝治疗长期抗血小板治疗房颤ACS抗栓原则抗栓原则平衡出血和血栓风险平衡出血和血栓风险个体化用药个体化用药出血血栓风险评估风险评估非瓣膜病房颤的血栓栓塞风险评估非瓣膜病房颤的血栓栓塞风险评估CHACHA22DSDS22-VASc-VASc评分评分出血风险评估出血风险评估HAS-BLEDHAS-BLED评分评分CHACHA22DSDS22-VASc-VASc评分评分RiskfactorsRiskfactorsScoresScoresCongestiveheartfailure/LVdysfunctionCongestiveheartfailure/LVdysfunction11HypertensionHypertension11Age>75Age>7522DiabetesmellitusDiabetesmellitus11Stroke/TIA/thrombo-embolismStroke/TIA/thrombo-embolism22VasculardiseaseaVasculardiseasea11Age65Age65––747411Sexcategory(i.e.femalesex)Sexcategory(i.e.femalesex)11MaximumscoreMaximumscore99根据评分选择抗凝策略根据评分选择抗凝策略RiskcategoryRiskcategoryCHA2DS2-VAScCHA2DS2-VAScscorescoreRecommendedRecommendedantithrombotictherapyantithrombotictherapyOneOne‘‘majormajor’’riskriskfactoror≥2factoror≥2‘‘clinicallyclinicallyrelevantnon-majorrelevantnon-major’’riskfactorsriskfactors≥≥2(male)2(male)≥≥3(female)3(female)OAC(I,A)OAC(I,A)OneOne‘‘clinicallyrelevantclinicallyrelevantnon-majornon-major’’riskfactorriskfactor1(male)1(male)2(female)2(female)OAC(IIa,B)OAC(IIa,B)NoriskfactorsNoriskfactors00NoOACNoOACNoAPDNoAPD2016ESCGuidelinesforthemanagementofatrialfibrillationdevelopedincollaborationwithEACTS.Europace.2016Aug27.HAS-BLEDHAS-BLED评分评分LetterLetterClinicalcharacteristicaClinicalcharacteristicaPointsawardedPointsawardedHHHypertensionHypertension11AAAbnormalrenalandliverAbnormalrenalandliverfunction(1pointeach)function(1pointeach)1or21or2SSStrokeStroke11BBBleedingBleeding11LLLabileINRsLabileINRs11EEElderly(e.g.age>65yearsElderly(e.g.age>65years11DDDrugsoralcohol(1pointeach)Drugsoralcohol(1pointeach)1or21or2Maximum9pointsMaximum9points0-2分为出血低风险患者，≥3分时提示患者出血风险高。冠心病合并房颤抗栓方案选择冠心病合并房颤抗栓方案选择稳定型冠心病合并房颤ACS合并房颤PCI围术期合并房颤稳定型冠心病合并房颤抗栓方案选择稳定型冠心病合并房颤抗栓方案选择方案方案栓塞栓塞风险风险高危高危VKAVKA单药治疗，不建议加用阿司匹林单药治疗，不建议加用阿司匹林低中危低中危阿司匹林阿司匹林100mg/d100mg/d栓塞低危、出栓塞低危、出血高危血高危阿司匹林（阿司匹林（75-100mg75-100mg）...