心房細動における脳卒中予防:体系的なレビュー

Gregory Y H Lip¹, Deirdre A Lane²

¹University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom2Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

JAMA

|May 20, 2015

まとめ

口服抗凝固薬は,心房細動 (AF) の脳卒中リスクを大幅に軽減します. AFと少なくとも1つの危険因子を持つ患者は,効果的な脳卒中予防のために,経口抗凝固剤を提供する必要があります.

科学分野:

心臓病学心臓病学
神経学神経学とは
薬理学薬理学とは

背景:

心房細動 (AF) は,死亡率,発症率,脳卒中のリスクを大幅に増加させます.
AF関連の脳卒中は,非AFの脳卒中と比較して,より高い死亡率,障害,および長期の入院を伴う.

研究の目的:

AF患者の脳卒中予防における現在のコンセプトと最近の進歩をレビューする.
AFにおける脳卒中のリスクを減らすための実践的な管理の提案を提供すること.

主な方法:

2015年3月11日まで,MEDLINEを使用して,包括的な文献検索が行われました.
研究は,心房細動,脳卒中,出血のリスク,および予防戦略に焦点を当てました.

主要な成果:

ビタミンKアンタゴニスト (VKA) やVKA以外の経口抗凝固剤 (NOAC) を含む抗凝固剤治療は,AFにおける脳卒中のリスクを効果的に軽減します.
口服抗凝固薬 (OAC) は,CHA2DS2-VAScスコアが1またはそれ以上のAF患者 (性別のみによるスコアが1の女性を除く) に推奨されます.
血圧をコントロールし,不必要な薬剤を避けるなど,出血のリスク要因の評価と管理は,OAC療法と並行して極めて重要です.

結論:

脳卒中の予防は,ペースやリズム制御に関係なく,AF管理の重要な側面です.
1つまたは複数の脳卒中リスク要因を有するすべてのAF患者は,経口抗凝固療法を検討すべきである.

さらに関連する動画

28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

34.4K

10:46

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

Published on: May 26, 2015

14.0K

関連する概念動画

01:29

Venous Thrombosis III: Interprofessional Care

471

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...

471

01:26

Coronary Artery Disease IV: Preventive Measures

866

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...

866

01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

2.5K

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...

2.5K

01:25

Dysrhythmias VI: Management of Dysrhythmias

633

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...

633

01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

2.8K

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...

2.8K

01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

680

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...

680

関連する実験動画