[AF-FORUM] 93S 转律和抗凝. Dr. Vidal

[AF Symposium]

各位医生
转律前即使是食道超声结果正常的患者也进行抗凝治 
疗，主要是为了防止转律后心房顿抑期间血栓的形 
成。这是所有类型的抗凝，无论是肝素还是华法令， 
均主要起着预防的意义。在房颤发作时心房血流会减 
弱，血流形成湍流使得血小板以及一些凝血因子激 
活，进而引起红细胞和纤维蛋白原黏附于心房壁（云 
雾状回声）。年龄并不会影响着一结果，同时，一些 
炎症因子如PCR、白介素等增加会诱发血栓的形成。也 
许有些人还会争论说为什么不在正常的食道超声检查 
后立刻应用肝素，因为食道超声也有敏感度的限制， 
而且部分患者也确实出现了一过性脑缺血发作。但是 
目前的事实就是：对于孤立性房颤、无器质性心脏 
病、而且无其他风险因素的情况下，没有抗凝指正。

Dr. Oscar Vidal
阿根廷 La Plata

---------------------------------------------------
Dear Dr.,
Anticoagulation prior to cardioversion, even with normal
transesophageal echo, is made to prevent clot formation during the
"stunning" period of myocardial fibers that occur after the
procedure. All types of anticoagulation made, whether with heparin or
oral anticoagulation is of the prophylactic type, to prevent the
formation of fibrin. If we remember the triad of Virchow, during AF
there is decrease of flow in the atrium, blood turbulence producing
platelet activation and coagulation factors, and why not red cells
adherence plus fibrinogen to endothelial wall (smog). Age does not
prevent these phenomena. Thus, also inflammatory phenomena that occur
in AF (increase of PCR, interleukins) contribute to triggering the
formation of clots. We could argue if we should use heparin
immediately with normal transesophageal echo (let us not forget the
sensitivity of the method to detect microthrombi and that in spite of
normal echo an ischemic attack may occur). The fact of not
anticoagulating patients without structural heart disease is
accompanied by lone AF, without risk factors, and no anticoagulation
indication.
Sincerely,
Dr. Oscar Vidal
Argentina La Plata

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee