CẬP NHẬT xử TRÍ nội KHOA RUNG NHĨ ở BỆNH NHÂN SUY TIM

CP NHT X TRÍ N BNH NHÂN SUY TIM

Nguyễn Hữu Trâm Em, Huỳnh Văn Minh
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

- 
- -

- A2DS2VASc =0
thì aspirin 75-



- 
- 
- 
- 



- Suy tim
- 
- 

- 
- 
- -74
- 

2DS2-VASc



1

1

2

1

2

1
-74
1

1
Điểm số tối đa
9
CHA2DS2-VASc score




0
1
0
1
422
1,3
2
1230
2,2
3
1730
3,2
4
1718
4,0
5
1159
6,7
6
679
9,8
7
294
9,6
8
82
6,7
9
14
15,2


uroHeart Survey
9



 
-

- -BLED Bleeding
Risk Score)
Ký



-
BLED

100 BN-
H
Hypertension (THA)
1
0
1.13
A
Abnormal renal and liver function



1

1.02
S

1
2
1.88
B

1
3
3.74
L

1
4
8.70
E

1


D









Chú thích:
H -  
A -             

               

S - 
B -  áu).
L -  
E - 
C - 


acenocoumarol (Sintrom)
and phenprocoumon (Marcoumar).

10

                   

arin.





-LY study

11
. Nghiên





d

 
xem xé

               

12





Hình 1 - Dabigatran etexilate







13






Dabigatran

Warfarin duy trì INR 23
RE-LY




   
   

Rivaroxaban
20 mg o.d.
Warfarin
INR 23
ROCKET-AF,
14.000 BN


Không thua kém

    

Apixaban
5 mg b.i.d.
Warfarin

INR 23
ARISTOTLE,
18.205 BN


Hoàn thành vào tháng 4

Apixaban
5 mg b.i.d.
Aspirin
8132 mg o.d. Apixaban
5 mg b.i.d.
Aspirin
8132 mg o.d.
AVERROES
5.600 BN


Apix   


Edoxaban
30 mg/60 mg o.d.
Warfarin
ENGAGE-AF
TIMI 48
20.500 BN


   

3/2012


 
- 
- 

- 
-  
- 


)
 
14,15



u tiên
 gây triu chng nng
Tui tr
Khó kim soát nhp th
Bp nhanh có th phc hi
Suy tim liên quan vi nhp nhanh
Có th 
Bng
c không triu chng
Tui cao (>75 t)

Có ch t c nhp gì

Các qun th t bit (ph ni cao huyt áp)
Tht bi vu tr chuyn nhp
Bng

8
:
 
- 
- 
- 
- 

- 
- 
- 


PIAF
STAF
RACE
AFFIRM

252
200
522
4060


19,6 tháng




61,5
65,8
68
69,7




<6 tháng


phát


2

tái phát cao






55,1%
10%
22,6%

 

60,8%
9%
17,2%


0,317
0,99
0,11
0,08


vo

17-19


Đối với mục tiêu kiểm soát nhịp (chuyển nhịp )
8,10,20-25



 


 



warfarin 25-    



               


-


 

 


Đối với mục tiêu kiểm soát tần số
26-30
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    
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-xi không dihydropyridine



.
31
Có thể là không thận trọng nếu sử dụng amiodarone ở BN rung nhĩ kéo dài hơn 48 giờ mà
không dùng kháng đông trước đó, trừ khi huyết khối nhĩ trái được loại trừ với SATQ.




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 suy tim
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
1/ X
 

  



 
o  

o 

 
                

 ngiotensin),
     



o 

o      

                  

o               -  

o K


 

 
 -3










1. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the
Management of Patients with Atrial Fibrillation: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines and the
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