[AF-FORUM] 52 S: 郊区抗凝问题

[AF Symposium]

各位同道

我有位75岁病人，慢性房颤。住在郊区，距离正规医 
院很远，1年前缺血性中风，左半身瘫痪，有一定程 
度的恢复。
两个月前，再次TIA发作而来诊，我给与其小剂量华法 
令渐进性治疗，但是出现鼻杻，遂改为阿司匹林。但 
1月前因拟行经尿道前列腺肥大手术再次停药。术后第 
5天开始服用阿司匹林，但1周后因上消化道出血入院 
（出血性胃炎）。

现在他仅服用洛沙坦，心率尚满意，我下一步应给与 
他什么治疗？应用Clopidogrel?但很可能他负担不起。

Dr. Luciano Pereira



52S: Anticoagulation in rural area. Dr. Pereira

Dear colleagues,
I have a 75-year-old patient, with chronic fibrillation. He lives in
a rural community with difficult access to qualified care centers. A
year ago he had ischemic stroke, with the sequel of left hemiparesis
with acceptable rehabilitation.
Two months ago he had another transient ischemic attack, and then he
came to my office. I started anticoagulation with warfarin, in
progressive doses with close control, which did not prevent however,
hospitalization due to epistaxis. Warfarin was suspended, and I
thought that he should settle with antiaggregation with aspirin (much
to my regret). A month ago, we suspended aspirin because he had to
undergo transurethral resection of benign prostatic hypertrophy.
He restarted his aspirin since the 5th day, and once again he had to
be hospitalized a week later after high digestive hemorrhage
(hemorrhagic gastritis).
Currently he is only taking potassium losartan, and he is in an
acceptable heart rate. What therapeutic possibilities could I offer
him in terms of antiaggregation? Clopidogrel? Most likely he won't be
able to afford it.
Kind regards,
Dr. Luciano Pereira
Paraguay


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee