2010.02.07. 22:22
a Schwarzwaldklinik
80 000 Ft-ért. Vagy úgy, hogy mégis csak jobb, mint a mátészalkai járási kórház, és ha már kiapadóban van a szülői apanázs, az ember ne nagyon válogasson.
2010.02.06. 19:04
így kezdődik ...
Victor éppen blogolni tanul. Meg lizálni, meg antikoagulálni.
Atrial fibrillation is the most common form of arrhythmia. Atrial fibrillation increases the risk of stroke by five times in people 65 years and older. Treatment of atrial fibrillation with anticoagulant therapy is known to reduce the incidence of CVA. Fifteen percent (15%) of CVA’s have cardiac origin. Two-thirds of these are due to atrial fibrillation.
Antithrombotic Therapy for Patients with Atrial Fibrillation Risk Category | Recommended Therapy | ||
No risk factors | Aspirin, 81-325 mg daily | ||
1 moderate-risk factor | Aspirin, 81-325 mg daily, or warfarin (INR 2.0-3.0, target 2.5) | ||
Any high-risk factor or >1 moderate-risk factor | Warfarin (INR 2.0-3.0, target 2.5)* | ||
Less Validated or Weaker Risk Factors | Moderate-Risk Factors | High-Risk Factors | |
Female gender | Age ≥ 75 years | Previous stroke, TIA, or embolism | |
Age 65-74 years | Hypertension | Mitral stenosis | |
Coronary artery disease | Heart failure | Prosthetic heart valve* | |
Thyrotoxicosis | LV ejection fraction diabetes mellitus ≤35%, | ||
The benefits of anticoagulant therapy are well-documented in studies. Coumadin is the preferred medication. Aspirin is better than placebo. Surveys show coumadin is underutilized in patients with atrial fibrillation. Use Aspirin in low-risk patients or those who refuse to take coumadin.
Patients with any high-risk factor or more than one moderate-risk factor should be prescribed an anticoagulant. High risk factors include prior stroke, transient ischemic attack or systemic embolus, rheumatic mitral stenosis, and prosthetic heart valve. Moderate risk factors include age > 75 years and diabetes mellitus. Patients who have paroxysmal atrial fib, reoccurrences of atrial fibrillation or those who have been in atrial fibrillation longer than 48 hours prior to conversion to a sinus rhythm should be placed on coumadin for one month and reevaluated by their practitioner. Strong consideration should be given to prescribing indefinite anticoagulation particularly in high risk patients.
There are contraindications regarding prescribing anticoagulation. Contraindications include:
- Uncorrected major bleeding disorder- thrombocytopenia, haemophilias, liver failure, renal failure
- Uncontrolled severe hypertension-systolic greater than 200mmHg or diastolic greater than 120 mmHg
- Potential bleeding lesions-active peptic ulcer, esophageal varices, aneurysm, proliferative retinopathy, recent organ biopsy, recent trauma or surgery to the head, orbit or spine, recent stroke, confirmed intracranial or intraspinal bleed
- Uncooperative/unreliable patient
- Repeated falls or unstable gait
- Concomitant use of NSAIDS-increased risk of GI bleed-relative-try to stop NSAIDS
- Protein C deficiency- risk of skin necrosis on initiation of treatment, so caution needed
Contraindications to anticoagulants should be documented and readily visible in the patient’s medical record.