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1、心房颤动抗栓治疗进展北京大学人民医院心脏中心孙艺红TheEpidemiologyofAFinChinaandotherCountries5.5%5.4%≥50yrs,USA(CHS),singleECG≥65yrs,UK,singleECG≥60yrs,Netherlands,singleECG&medicalrecord≥50yrs,UK,singleECG≥55yrs,Netherlands,singleECG≥35yrs,USA,medicalrecord≥50yrs,UK,singleECGReviewresults≥
2、60yrs,Australia,triennialsurvey≥40yrs,Japan,singleECG≥60yrs,HongKong,singleECG≥35yrs,mainland,China,singleECG≥35yrs,Denmark,singleECG25-64yrs,westGerman,singleECG≥15yrs,India,singleECG0.1%5.1%3.7%3.0%2.8%2.4%1.5%1.3%1.3%0.77%0.60%0.28%PatientswithAFInChina8millionTh
3、eEpidemicofAtrialFibrillationIncreasingprevalenceofriskfactorsforAF:OlderageSystemichypertensionHeartfailureValvularheartdiseaseDiabetesmellitusObesityPrevalenceofStrokeinPatients withNVAFStratifiedbyAgeyears0510152025Prevalence(%)30>4040～4960～6950-5970～79>80HUD,eta
4、l.ChinJInternMed,2003;42:157-161EfficacyofWarfarininAtrialFibrillationCombinedEndpointOccurrence(%)Follow-up（m）0612182402015105Aspirin(150-160mg)Warfarin(INR2.0-3.0)RRR36%13.0%8.4%NetClinicalOutcomeTheRandomizedProspectiveTrialcomparedaspirinwithadjusted–dosewarfari
5、ninNVAFPatientsP=0.01TheCovalentGroup,Inc.Theoptimalintensityofanticoagulation<1.51,5-1.92.0-2.42.5-2.93.0-3.43.5-3.9>4.0INREmbolicHemorrhage43.53.02.52.01.51.00.50INR2-3AnticoagulationofAFinReal-life10090807060504030201053.5%9.8%37.0%43.7%8.9%47.3%NoantithromboticW
6、arfarinaspirinEligible*(n=3944)Ineligible(n=562)*patientswithatleastonehigh-moderateriskfactorsaccordingtoACC/AHAguideline2006TheAbsoluteIncidenceofBleedingHemorrhageofin-hospitalpatientswithNVAFinChinaHuD,etal.2004ChinJInternMedP=0.001WARFARINASPIRINNO1.4%6.3％3.3%M
7、INOR（5.3%）MAJOR（1%）%987654321TheDilemmaofAnticoagulationManagementWarfarinhasanarrowtherapeuticwindowofeffectivenessandsafety.Manyfactorsinfluenceapatient’sstabilityinthatwindow.Frequentmonitoringisrequiredtomaintainpatientsinthetherapeuticwindow.Monitoringislaborin
8、tensiveandcomplex.Physiciansavoidwarfarinusebecauseofitscomplexity.BalancingRiskandBenefitImproveriskstratificationImproveanticoagulationc
