1、楊杰孚，北京醫院嶺南會議之ACC抗凝論壇2019. 4. 12，廣州Updates on Guidelines, Glance at Real-world:ACC房顫抗凝領域熱點l從臨床實驗到指南構成：l依托大型臨床實驗，學會指南延續更新發表l從指南引薦到臨床運用：l真實世界數據初步積累:房顫指南接踵發表:Associated Guidelines and StatementsTitleOrganizationYearGuidelinesAssessment of Cardiovascular Risk in AsymptomaticAdultsACCF/AHA2019Atrial Fibri

2、llationCCS2019Atrial FibrillationESC2019Device-Based TherapyACCF/AHA/HRS2019Antithrombotic TherapyACCP2019Valvular Heart DiseaseAHA/ACC2019Atrial FibrillationAHA/ACC/HRS2019StatementsTreatment of Atrial FibrillationAHRQ2019Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial

3、 Fibrillation: a Science Advisory for Healthcare ProfessionalsAHA/ASA2019Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-Up, Definitions, Endpoints, and Research Trial Des

4、ignHRS/EHRA/ECAS20192019 AHA/ACC/HRS Atrial Fibrillation Guideline. Circulation. 2019;129:000000:Mechanisms of AF2019 AHA/ACC/HRS Atrial Fibrillation Guideline. Circulation. 2019;129:000000:Less than 15% of patients are CHA2DS2VASc 0-1:NOAC與華法林：我們根據什么為患者選擇抗凝藥物？lTo make them feel better/覺得更好lTo avoid

5、 unpleasant events/防止不良事件lTo let them live longer/生存更久:To make them feel better - NOAC:NOAC:To avoid unpleasant events NOACMedical Costs Avoided for Prevention of Stroke with Use of NOACs: Estimates for the Real World ; ACC 14:消化道出血：運用NOAC應留意的重要不良事件薈萃分析包括NOAC全部III期實驗New Oral Anticoagulants and Gastr

6、ointestinal Bleeding: Insights from Meta-analyses and Trial Sequential Analyses of Randomized Clinical Trials; ACC 14 :To let them live longer:NOAC：新指南更多引薦: 腎功能不全 高血壓 糖尿病 聯用抗血小板藥物NVAF患者抗凝治療預防卒中重要危險要素:房顫患者血栓栓塞事件隨腎功能下降顯著添加:卒中/栓塞風險、主要出血風險與肌酐去除率相關Apostolakis S et al. Eur Heart J 2019;eurheartj.eht328 慢性

7、腎病是NVAF患者卒中預防的重要危險要素Chronic kidney disease is an important risk factor for stroke in NVAF:抗凝治療針對腎功能調整劑量:NVAF患者抗凝治療預防卒中應注重血壓控制Poorly Controlled Blood Pressure is Independently Associated with a 50% Higher Risk of Stroke or Systemic Embolism in Patients with Atrial Fibrillation: Results from the ARIST

8、OTLE Trial；ACC 14:伴糖尿病NVAF患者運用NOAC獲益更大Apixaban Compared with Warfarin in Patients with Diabetes and Nonvalvular Atrial Fibrillation in the ARISTOTLE Trial；ACC14:NVAF患者運用NOAC抗凝預防卒中應防止聯用抗血小板藥物 Novel Oral Anticoagulants and Antiplatelet Therapy for Stroke Prevention in Atrial Fibrillation: a Meta-analy

9、sis; ACC 14:ACC房顫抗凝領域熱點l從臨床實驗到指南構成：l依托大型臨床實驗，學會指南延續更新發表l從指南引薦到臨床運用：l真實世界數據初步積累:真實世界研討：臨床運用抗凝藥物相關要素Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) registry; ACC 14:真實世界研討：臨床運用抗凝藥物停藥率比較Real World Discontinuation Rates with Apixaban versus Warfarin, Dabigatran or Rivaroxaban among Atrial Fibrillation Patients Newly Initiated on Anticoagulation Therapy: Early Findings; ACC 14:小結AHA/ACC/HRS2019房顫新指南明確采用CHA2DS2-VASC評分指點抗凝積分2為高