[AF-FORUM] 43P 抗凝. Dr. Campodonico F

[AF Symposium]

Calatayud,医生

我同意Oscar抗凝的观点。
尽管研究房颤的血栓栓塞预防的实验（Stroke Prevention  
of Atrial Fibrillation中试验 I 和II）没有强调心衰的问 
题，但实际上分别有10%和45%合并心衰；在Second  
Copenhagen Atrial Fibrillation, Aspirin and Anticoagulation (AFASAK  
2)试验中，大概50%也是这种情况。
统一来讲，这5个经典安慰剂对照试验显示华法令降低 
65%栓塞发生率，增加53%出血风险，乙酰水杨酸效果较 
差，与安慰剂比降低栓塞风险21%。所有结果显示年龄 
70-75患者颅内出血风险更高。因此，我的患者多建议 
INR在2左右，或者对于出血可能性较大的患者我给与 
乙酰水杨酸治疗。
其他的一些抗血小板药物仍在研究，但结果似乎并不 
乐观。
Ximelagartan，一种新的直接凝血酶抑制剂，经过了两个 
大规模试验的评估。
至于替代乙酰水杨酸药物，很多抗炎性反应药物 
(diclofenac, ibuprofen, COX2 抑制剂)长期应用似乎均与心梗 
发作相关，我更倾向应用扑热息痛

Dr.Sidney C F,
巴西

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Re: [AF-FORUM] 43P Anticoagulation. Dr. Campodonico F
Doctor Calatayud,

I agree with Dr. Oscar about anticoagulation.
Although the great studies that assessed the role of primary
prevention of thromboembolism by AF were not addressed to the
population with heart failure, in trials I and II from the study
Stroke Prevention of Atrial Fibrillation, there was respectively 10
and 45% of carriers of HF; and in the Second Copenhagen Atrial
Fibrillation, Aspirin and Anticoagulation (AFASAK 2), a somewhat
above a 50% presented with this association.
Jointly, the five classical studies controlled with placebo revealed
a 65% reduction of embolism with warfarin, with a 53% increase in the
rate of hemorrhage. Acetylsalicylic acid presented a lower efficacy,
with 21% of reduction of embolic events in relation to placebo.
Everything indicates that patient with ages ranging between 70-75
years, have a greater risk of intracranial hemorrhage; for this
reason, I advise my patients to keep an INR near 2 or I prescribe
acetylsalicylic acid to those that have a greater likelihood of
hemorrhagic phenomena.
Other great antiplatelet agents are being tested, but they are not
showing promising results.
The agent ximelagartan (a new direct inhibiting agent of thrombin)
was assessed in two large trials.
As to the substitution of ASA by diclofenac, many anti-inflammatory
agents (diclofenac, ibuprofen, COX2 inhibitors) seem to be linked to
events of death by infarction, mainly in chronic use. I prefer using
paracetamol.
Warm regards,
Dr.Sidney C F,
(Brazil)

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee