clinicalcardiologypracticeupdate心血管病临床实践的新认识.ppt

Clinical Cardiology Practice Update心血管病臨床實踐的新認識 Paul Chan(Chen), MD, PhD, FACC, FRCP, FCP Division of Cardiovascular Medicine, Taipei Medical University-Wan Fang Hospital, Taiwan 陳保羅醫師/教授 台灣台北醫學大學萬芳醫院 心臟內科 Atrial Fibrillation(AF房顫) Most prevalent arrhythmia, strong independent risk factor for embolic stroke 最常見的心律失常 Prevalence (盛行率) 0.4% ; 60 year-old 1% ; 80 year-old 6% Mitral stenosis, cardiomyopathy, heart failure, emboli, hypertension, and other major risk factors use warfarin No major comorbid factors : 325 or 100 mg/day aspirin Bleeding episodes: warfarin 0.62% vs. aspirin 0.17% (p0.001) 出血的併發症 P. Chan 2009 Anticoagulation in AF房顫的抗凝血治療 In evaluating antithrombotic therapy to prevent stroke in patients with atrial fibrillation, these randomized trials compared adjusted-dose warfarin versus placebo Warfarin Better Control Better P. Chan 2009 Ann Intern Med 1999 ; 131 : 492-501 Meta-Analysis of Warfarin Versus Placebo房顫使用華法令與安慰劑比較 Study (Reference) Warfarin Group Placebo group Relative Risk Reduction Strokes Participants Strokes Participants ( 95% CI ) P n n % AFASAK 9 335 19 336 54 --- SPAF 8 210 19 211 60 0.005 BAATAF 3 212 13 208 78 0.005 CAFA 6 187 9 191 33 --- SPINAF 7 281 23 290 70 0.005 EAFT* 20 225 50 214 68 0.005 All trials 53 1450 133 1450 62 (48-72) AFASAK=Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study ; BAATAF=Boston Area Anticoagu