[AF-FORUM] 90E Transient Ischemic Attack. Dr. Natell

[AF Symposium]

她在应用抗血小板药物吗?显然如果没有禁忌她应该 
予以阿司匹林治疗，如果仍不够可合并应用clopidogrel  
或dipyramidamole

她的TIA发作也可能与房颤无关（如颈动脉起源栓 
子），若如此则抗血小板治疗即足够。

如果还没进行相关检查，那么颈动脉多普勒或者CT， 
食道超声证实栓子来源于颈动脉或者心房会有帮助。 
如果确切心房起源，抗血小板治疗强度还不够，而华 
法令抗凝又不行，也许可以选择左心耳封堵治疗。见 
文献：Sick PB et al, Initial worldwide experience with the WATCHMAN  
left atrial appendage system for stroke prevention in atrial  
fibrillation. J Am Coll Cardiol. 2007 Apr 3;49(13):1490-5.

Stanley Nattel, MD

Paul-David Chair in Cardiovascular Electrophysiology
Professor of Medicine
University of Montreal

Director, Electrophysiology Research Program
Montreal Heart Institute Research Center
5000 Belanger St. E.
Montreal, Quebec
Canada H1T 1C8

T: 514-376-3330 ext 3990
F: 514-376-1355
e-mail:
stanleynattel在aol.com
stanley.nattel在icm-mhi.org

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Re: [AF-FORUM] 90E Transient Ischemic Attack. Dr. Natell
  Is she getting antiplatelet drugs? She should obviously be on ASA if
there
are no contraindications, and if that is not sufficient ASA plus
clopidogrel or dipyramidamole.

Her TIAs could be unrelated to the AF (eg, carotid artery sources), in
which case the antiplatelets might be enough.

If not already done, carotid Doppler or CT and transesophageal echo
to look
for evidence of LA thrombus would be useful to get a sense of whether
the
events are cardiac or carotid artery in source.

If there is clear evidence of an atrial source or if antiplatelets are
insufficient, and anticoagulation is really impossible, you may want to
consider an LAA occlusion device, eg see


   Sick PB et al, Initial worldwide experience with the WATCHMAN left
atrial appendage system for stroke prevention in atrial fibrillation.
   J Am Coll Cardiol. 2007 Apr 3;49(13):1490-5.



Stanley Nattel, MD

Paul-David Chair in Cardiovascular Electrophysiology
Professor of Medicine
University of Montreal

Director, Electrophysiology Research Program
Montreal Heart Institute Research Center
5000 Belanger St. E.
Montreal, Quebec
Canada H1T 1C8

T: 514-376-3330 ext 3990
F: 514-376-1355
e-mail:
stanleynattel在aol.com
stanley.nattel在icm-mhi.org

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee