 What’s New in Non-VKA Oral Anticoagulant? Assessing the Latest Evidence | |
| 主辦單位 | 社團法人高雄縣醫師公會 |
| 上課日期時間 | 109年09月10日（星期四）12:30~14:30 |
| 上課地點 | 社團法人高雄縣醫師公會 |
| 報名截止日期 | 2020/09/08 |
| 講師 | 方志元／長庚醫療財團法人高雄長庚紀念醫院心臟血管內科 |
| 課程大綱 | Selecting an Anticoagulant Regimen For patients with AF and an elevated CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism [doubled], vascular disease, age 65-74 years, sex category) score of 2 or greater in men or 3 or greater in women, oral anticoagulants are recommended. Female sex, in the absence of other AF risk factors (CHA2DS2-VASc score of 0 in males and 1 in females), carries a low stroke risk that is similiar to males. Adding female sex to the CHA2DS2-VASc score matters for age >65 years or ≥2 non–sex-related stroke risk factors. Non-vitamin K oral anticoagulants (NOACs) (dabigatran, rivaroxaban, apixaban, and edoxaban) are recommended over warfarin in NOAC-eligible patients with AF (except those with moderate-to-severe mitral stenosis or a mechanical heart valve). In patients with AF (except those with moderate-to-severe mitral stenosis or a mechanical heart valve), the CHA2DS2-VASc score is recommended for assessment of stroke risk. For patients with AF who have mechanical heart valves, warfarin is recommended. Renal and hepatic function should be evaluated before initiation of a NOAC, and both should be reevaluated at least annually. Aspirin is no longer recommended for patients with low CHA2DS2-VASc scores. For patients with AF (except those with moderate-to-severe mitral stenosis or a mechanical heart valve) and a CHA2DS2-VASc score of 1 in men or 2 in women, clinicians may consider prescribing an oral anticoagulant to reduce the risk of thromboembolic stroke. AF Complication ACS In patients with AF at increased risk of stroke (based on CHA2DS2-VASc risk score of ≥2) who have undergone percutaneous coronary intervention (PCI) with stenting for acute coronary syndrome (ACS), the following is reasonable to reduce the risk of bleeding as compared with triple therapy (oral anticoagulant, aspirin, and P2Y12 inhibitor): @Double therapy with a P2Y12 inhibitor (clopidogrel or ticagrelor) and dose-adjusted vitamin K antagonist. @Double therapy with P2Y12 inhibitors (clopidogrel) and low-dose rivaroxaban 15 mg daily. @Double therapy with a P2Y12 inhibitor (clopidogrel) and dabigatran 150 mg twice daily. If triple therapy is prescribed for patients with AF who are at an increased risk of stroke (based on CHA2DS2-VASc risk score of ≥2) and who have undergone PCI with stenting (drug eluting or bare metal) for ACS, clinicians may consider a transition to double therapy (oral anticoagulant and P2Y12 inhibitor) at 2-4 weeks. |
| 積分 | 西醫師繼續教育積分-專業課程、 家醫科、內科 |