文档介绍：房颤的治疗方案
工作总结
商务报告
商务展示
工作计划
房颤的定义
房颤是指规则有序的心房电活动丧失，代之以快速无序的颤动波，是最严重的心房电活动紊乱。心房无序的颤动失去了有效的收缩与舒张，心房泵血功能恶化或’ risk factors
‘Clinically relevant non-major’
risk factors
Heart failure or moderate to
severe LV systolic dysfunction
Hypertension
Age > 75 years
Diabetes mellitus
Previous stroke, TIA,
or systemic embolism
Vascular diseasea
Age 65–74 years
Female sex
(b) Risk factor-based approach expressed as a point based
scoring system, with the acronym CHA2DS2-VASc
(Note: maximum score is 10 since age may contribute 0, 1, or 2 points)
血栓栓塞风险评估CHA2DS2-VASc
Risk factors
Scors
Congestive heart failure/LV dysfunction
1
Hypertension
1
Age >75
2
Diabetes mellitus
1
Stroke/TIA/thrombo-embolism
2
Vascular diseasea
1
Age 65–74
1
Sex category (. female sex)
1
Maximum score
9
血栓栓塞风险评估CHA2DS2-VASc
Risk category
CHA2DS2-VASc
score
Recommended
antithrombotic therapy
One ‘major’ risk
factor or >2 ‘clinically
relevant non-major’
risk factors
> 2
OAC
One ‘clinically relevant
non-major’ risk factor
1
Either OAC or
aspirin 75–325 mg daily.
Preferred: OAC rather
than aspirin
No risk factors
0
Either aspirin 75–
325 mg daily or no
antithrombotic therapy.
Preferred: no
antithrombotic therapy
rather than aspirin.
出血风险评估HAS-BLED
Letter
Clinical characteristica
Points awarded
H
Hypertension
1
A
Abnormal renal and liver
function (1 point each)
1or2
S
Stroke
1
B
Bleeding
1
L
Labile INRs
1
E
Elderly (. age >65 years
1
D
Drugs or alcohol (1 point each)
1or2
Maximum 9 points
华法林的应用
华法林通过减少凝血因子II、VII、IX与X的合成等环节发挥抗凝作用。只有所有依赖于维生素K的凝血因子全部被抑制后才能发挥充分的抗凝作用，因此华法林的最大疗效多于连续服药4-5天后达到，停药5-7天后其抗凝作用才完全消失。
华法林的应用
美国等指南推荐华法林的起始治疗剂量为5mg/d-10mg/d，但由于种族和体重差异，我国人群应用华法林治疗时从较低剂量（-）开始。初始剂量治疗INR不达标时，-，直至其达到目标值（INR -；-）。特殊人群（如老年人、体质虚弱、营养不良、心力衰竭、肝脏疾病、近期曾进行手术治疗、或正在服用可增强华法林作用的药物者）应从更低剂量（如<）开始用药。
INR的监测频度应视患者具体情况而定。应用华法林治疗初期，至少应每3-5日检测一次I