Kelley R E
Department of Neurology, University of Miami School of Medicine, Florida.
Neurol Clin. 1992 Feb;10(1):233-49.
Antithrombotic therapy is clearly indicated in patients with atrial fibrillation who have associated factors that put them at significant risk for thromboembolism This does not include subjects with lone atrial fibrillation who are less than 60 years of age. High-risk patients include those with valvular heart disease, recent congestive heart failure, severe left ventricular dysfunction by echocardiography, prior thromboembolism, demonstration of a cardiac thrombus by echocardiography, and thyrotoxicosis. Anticoagulant therapy appears to be the most efficacious means of preventing thromboembolism in atrial fibrillation. Potential bleeding complications with sodium warfarin mandate judicious selection of patients for long-term anticoagulant therapy. The risk of anticoagulant therapy certainly appears justified in subjects who are at high risk for thromboembolism and can be monitored with a reasonable degree of safety. Aspirin therapy is a reasonable alternative for those subjects at relatively lower risk of thromboembolism, especially subjects who are not suitable candidates for anticoagulation. The efficacy of aspirin has not been established in patients with atrial fibrillation who are greater than 75 years of age.
对于伴有增加血栓栓塞显著风险相关因素的房颤患者，抗栓治疗显然是必要的。这并不包括年龄小于60岁的孤立性房颤患者。高危患者包括患有心脏瓣膜病、近期发生充血性心力衰竭、经超声心动图检查显示严重左心室功能不全、既往有血栓栓塞史、经超声心动图检查发现心脏血栓以及甲状腺毒症患者。抗凝治疗似乎是预防房颤患者血栓栓塞最有效的方法。华法林钠潜在的出血并发症要求谨慎选择长期抗凝治疗的患者。对于血栓栓塞高危且能在合理安全程度下进行监测的患者，抗凝治疗的风险显然是合理的。对于血栓栓塞风险相对较低的患者，尤其是不适合抗凝治疗的患者，阿司匹林治疗是一种合理的替代方法。阿司匹林在75岁以上房颤患者中的疗效尚未确定。
