Stroke and thromboembolism prevention in atrial fibrillation.
Stroke and thromboembolism prevention in atrial fibrillation.
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DOI：
10.1136/heartjnl-2019-314898
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发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
Barnes G
中科院分区：
文献类型：
--
作者：
Jame S;Barnes G
预防卒中和全身血栓栓塞仍然是房颤（AF）和房扑管理的基石。目前已有多种卒中和全身血栓栓塞风险评估模型。该评分及其已知的局限性，仍然是大多数主要指南中推荐的风险分层工具。一旦确定有风险的患者，维生素K拮抗剂（VKA）和最近的直接口服抗凝剂（DOAC）是预防卒中的主要药物治疗。对于长期抗凝治疗禁忌症患者，左心耳封堵器正在发展成为一种可能的替代疗法。关于急性房颤（<48小时）心脏复律的抗凝管理存在一些争议;然而，对于房颤持续时间较长的患者，建议在心脏复律前和心脏复律后进行全身抗凝。房颤消融术前后的抗凝管理也在不断发展。已证明不间断VKA和DOAC治疗可降低围手术期血栓栓塞风险，大出血无显著增加。目前，正在研究的是一种最小中断的DOAC围消融期抗凝方法。问题仍然存在，特别是关于抗凝治疗的提供和可穿戴心律监测仪在AF管理中的整合。
Prevention of stroke and systemic thromboembolism remains the cornerstone for management of atrial fibrillation (AF) and flutter. Multiple risk assessment models for stroke and systemic thromboembolism are currently available. The score, with its known limitations, remains as the recommended risk stratification tool in most major guidelines. Once at-risk patients are identified, vitamin K antagonists (VKAs) and, more recently, direct oral anticoagulants (DOACs) are the primary medical therapy for stroke prevention. In those with contraindication for long-term anticoagulation, left atrial appendage occluding devices are developing as a possible alternative therapy. Some controversy exists regarding anticoagulation management for cardioversion of acute AF (<48 hours); however, systemic anticoagulation precardioversion and postcardioversion is recommended for those with longer duration of AF. Anticoagulation management peri-AF ablation is also evolving. Uninterrupted VKA and DOAC therapy has been shown to reduce perioperative thromboembolic risk with no significant escalation in major bleeding. Currently, under investigation is a minimally interrupted approach to anticoagulation with DOACs periablation. Questions remain, especially regarding the delivery of anticoagulation care and integration of wearable rhythm monitors in AF management.
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影响因子：
39.3
作者：
Kirchhof P;Haeusler KG;Blank B;De Bono J;Callans D;Elvan A;Fetsch T;Van Gelder IC;Gentlesk P;Grimaldi M;Hansen J;Hindricks G;Al-Khalidi HR;Massaro T;Mont L;Nielsen JC;Nölker G;Piccini JP;De Potter T;Scherr D;Schotten U;Themistoclakis S;Todd D;Vijgen J;Di Biase L
通讯作者：
Di Biase L
影响因子：
6.1
作者：
Hansen, Morten Lock;Jepsen, Rikke Malene H. G.;Torp-Pedersens, Christian
通讯作者：
Torp-Pedersens, Christian
DOI：
10.1161/circinterventions.117.005359
发表时间：
2017-11-01
影响因子：
5.6
作者：
Asmarats, Lluis;Rodes-Cabau, Josep
通讯作者：
Rodes-Cabau, Josep
影响因子：
24
作者：
Holmes, David R., Jr.;Kar, Saibal;Reddy, Vivek Y.
通讯作者：
Reddy, Vivek Y.
DOI：
10.1016/j.amjmed.2015.05.044
发表时间：
2015-12
期刊：
The American journal of medicine
影响因子：
--
作者：
Barnes GD;Lucas E;Alexander GC;Goldberger ZD
通讯作者：
Goldberger ZD