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2012年美国胸科医师学院(ACCP)第9版《抗栓治疗和血栓预防指南》在心房颤动(AF)抗栓治疗中强调基于CHADS2评分的危险分层抗栓策略,CHADS2评分≥1分患者均应给予口服抗凝药物,包括华法林(国际标准化比值目标2.0～3.0)和新型口服抗凝药物达比加群。不推荐应用抗血小板治疗。此外,还对特殊情况如合并冠心病以及复律时的抗凝治疗给予建议。多数风湿性瓣膜病和机械瓣膜置换术后需要口服华法林。发生感染性心内膜炎的患者不建议抗凝治疗,如患者长期抗凝也要暂时停用直至病情稳定。机械瓣膜置换术后长期华法林抗凝,人工瓣膜血栓的处理策略需要根据血栓大小和位置来决定溶栓还是外科手术治疗。
The 2012 American College of Chest Physicians (ACCP) Version 9 “Guidelines for Antithrombotic Therapy and Thromboprophylaxis” emphasizes the risk stratified antithrombotic strategy based on CHADS2 score in patients with atrial fibrillation (AF) antithrombotic therapy. Patients with CHADS2 score ≥1 Oral anticoagulants should be given, including warfarin (target international standard 2.0 to 3.0) and the new oral anticoagulant drug dabigatran. Antiplatelet therapy is not recommended. In addition, special cases such as coronary heart disease and cardioversion anticoagulation therapy given advice. Warfarin is prescribed orally after most rheumatic valvular disease and mechanical valve replacement. Patients with infective endocarditis do not recommend anticoagulant therapy, such as long-term anticoagulation in patients with temporary deactivation until stable. Long-term warfarin anticoagulation after mechanical valve replacement, prosthetic valve thrombosis treatment strategies need to decide according to thrombus size and location of thrombolytic or surgical treatment.