Guidelines for anticoagulant therapy of atrial fibrillation unscramble Fuwai Cardiovascular Hospital Jun Zhu Atrial fibrillation is an independent risk factor for severe stroke 风险率 ( 与无疾病个体相比 ) 4.8 4.3 3.4 疾病 房颤 心衰 高血压 冠心病 2.4 P < 0.001 Incidence of stroke (%) Wolf et al. 1991 Anticoagulation is an important strategy in the treatment of atrial fibrillation 基础疾病的治疗——“上游治疗” 室率控制 抗凝治疗 therapy Anticoagulation 抗心律失常药 转复 无症状 阵发 Camm AJet al. Eur Heart J2012 消融 AF 持续 长期持续 永久 Latest guidelines for the management of atrial fibrillation  2012 ESC Guidelines for Atrial Fibrillation  2012 American Association of Chest Physicians ACCP 9  NICE Guidelines for Atrial Fibrillation, UK, 2012  Canadian Guidelines for Atrial Fibrillation 2012  Expert consensus on catheter and surgical ablatio n of atrial fibrillation in 2012  Chinese Expert Consensus on Anticoagulation The rapy for Atrial Fibrillation in 2012  Stroke risk assessment  Bleeding risk assessment  Anticoagulation selection strategy and  Evaluation of different anticoagulants  Monitoring of anticoagulants  Anticoagulation special patients therapy for ESC 2010 atrial fibrillation guidelines recommend the use of CHA2DS2-VASc score to assess stroke risk Stroke, TIA or systemic embolism, and over 75 years of age were considered to be major risk fa ctors, while the rest were clinically related non-major risk factors. (b) 基于危险因素的 CHA2-DS2-VASc 评分 危险因素 心力衰竭 / 左心室功能不全 评分 1 高血压 1 糖尿病 1 年龄≥ 75 岁 2 卒中 / 一过性脑缺血发作 / 血栓－栓塞 2 血管疾病 a 1 年龄 65 － 74 岁 1 最多得分 9 性别因素 ( 如女性 ) Camm AJet al. Eur Heart J2012 1 Association between CHA2DS2-VASc score and stroke risk CHA2-DS2-VASc 评 患者 (n=73538) 1 年随访中的卒中与血栓血 栓事件发生率 (%) 9 46 23.64 8 285 22.38 7 1420 21.50 6 4244 19.74 5 8942 15.26 4 13887 9.27 3 17371 5.92 2 12771 3.71 1 8023 2.01 0 6369 0.78 分 Olesen JB, et al. BMJ. 2011; 342:d124. CHA2DS2-VASc and CHADS2 Find out the real low-risk patients 无卒中 / 血栓栓塞的患者比例 In patients with CHADS2=0, the C statistic was 0.537 (0.539-0.608); when included When CHA2DS2-VASc, this statistic increases to 0.641 (0.610-0.671). Olesen et al Thromb Haemost. 2012 Jun; 107 (6): 1172-9 自出院起的天数 The US ACCP 9 and Canada 2012 AF Guidelines contin ue to recommend CHADS2 CHADS2 评分 分数 罹患率 (%) 高血压 1 65 1 28 1 18 2 10 充血性心力衰竭 年龄 >75 岁 糖尿病 中风或 TIA 1 Advantages of CHADS2 Scoring 32 •Simple and practical •Suitable for finding real high-risk patients CHADS2 score is suitable for finding real high-risk patients 风险 中高危险 低危险 分数 罹患率 (%) ≥2 50--60 0-1 40-50 Chinese Expert Consensus on Anticoagulation Therapy for Atrial Fibrillation 2012 Van Walraven C, et al. Arch Intern Med 2003; 163:936. Nieuwlaat R, et al. Eur Heart J. 2006 Dec; 27 (24): 3018-26. The Difference between the Two Scores: Background and Idea • The Background of Two Scores • —— CHADS2 originated in the early days of the anticoagulant conc ept of non-valvular disease, and most patients did not receive antico agulant therapy. • —— CHA2DS2-VAS originated in Europe where anticoagulation th erapy is highly popular and standardized. • Two Scoring Concepts • —— CHADS2: Conduct risk stratification, identify high-risk patien ts, and anticoagulate high-risk patients. • —— CHA2DS2-VAS: Desalinate the risk stratification, find out the real low-risk, do not give low-risk patients anticoagulation, other are anticoagulant. Speech from the European Heart Conference in August 2011 Assessment of stroke risk in anticoagulation therapy for at rial fibrillation by consensus of Chinese experts "At present, CHASD2 scoring system is mainly used to assess stroke risk in China.CHADS2 scoring system is the most widely used evaluation tool in clinical application. With the increase of CHADS2 scoring system, the risk of ischemic stroke in patients with atrial fibrillation will gradually increase in the future. Chinese Society of Cardiovascular Diseases, Chinese Medical Association; Chinese Expert Consensus on Anticoagulation Th erapy for Atrial Fibrillation [J]; Chinese Journal of Internal Medicine; Volume 51, November 2012, No. 11  Stroke risk assessment  Bleeding risk assessment  Anticoagulation selection strategy and  Evaluation of different anticoagulants  Monitoring of anticoagulants  Anticoagulation special patients therapy for Criteria for risk assessment of hemorrhage in patients with atrial fibrillation 1 2 3 HAS-BLED (Hyper