课件：房颤房扑的规范化抗凝治疗.ppt

缺血性脑卒中1例、肿瘤1例、严重出血2例。阿司匹林组8例死亡中包括缺血性脑卒中2例、肿瘤2例、急性心肌梗死1例、严重心力衰竭1例、心脏骤停2例。 Figure 1. TEEs (horizontal plane) of the left atrium and left atrial appendage (patient No. 4 of the table). Panel A shows the left atrium and appendage in a 60-year-old woman affected by mitral stenosis and aortic regurgitation. The duration of atrial fibrillation was unknown. Note the pedunculated thrombus (white arrow) at the mouth of left atrial appendage. Panel B shows the same patient after 4 weeks of warfarin. The thrombus had completely resolved. Scant spontaneous echocontrast can be seen in left atrial appendage. Atrial Thrombi Resolution After Prolonged Anticoagulation in Patients With Atrial Fibrillation* A Transesophageal Echocardiographic Study Figure 7. Adjusted odds ratios for ischemic stroke and intracranial bleeding in relation to intensity of anticoagulation in randomized trials of antithrombotic therapy for patients with AF. The data are from Hylek et al (203,207). Hylek EM, Skates SJ, Sheehan MA, Singer DE. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 1996;335:540–6. Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 1994;120:897–902. 华法林的平均剂量为3.19±0.69 mg（1.5-5）。华法林达到目标范围的时间，平均为23日，（18-43天） 总血栓栓塞事件（缺血性卒中合并体循环栓塞）19例（5.4%），与INR的关系 INR2 占15例，INR2-3 占4例 华法林组总出血发生率为23例6.87%，其中严重出血5例（脑出血3例，上消化道出血2例），2例导致死亡；轻微出血18例（占5.37%）。但华法林组5例严重出血的INR值均3.0。牙龈出血5例，鼻2例，皮肤粘膜瘀斑7例，血尿2例，球结膜出血1例，阴道出血1例。 3482 次INR值分布 INR 0 1.0-1.4 1.0 1.5-1.9 2.0-2.4 2.5-2.9 3.0-3.4 3.5-3.9 4.0 70 60 50 40 30 20 10 % 2378（INR 2~3 , 68.3% ） Follow-up period :median 19m（2～24m） Mean dose of warfarin: 3.19±0.69 mg（1.5-5mg） 华发林组血栓栓塞事件 Combined Endpoint Occurrence (%) 0 2.0 1.5 1.0 0.5 2.5 3.0 INR 0 1.0-1.4 1.0 1.5-1.9 2.0-2.4 2.5-2.9 3.0 N=15 N=4 There were 19 cases of thromboembolic events, most of them occurred in INR 2.0. INR 2.0 华发林组出血事件 10 8 6 4 2 % I