作者：李树仁，曹君娴，王飞

单位：

1.050051河北省石家庄市，河北省人民医院心血管内一科　 2.150001黑龙江省哈尔滨市，哈尔滨医科大学附属第一医院心内三科 3.201800上海市，上海健康医学院附属嘉定区中心医院重症医学科

单位（英文）：

1.Cardiovascular Medicine, Hebei General Hospital, Shijiazhuang 050051, China 2.Department of Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China 3.Department of Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medical & Health Sciences, Shanghai 201800, China

关键词：

心房颤动; 抗凝; 直接口服抗凝药; 栓塞; 出血; 风险评估; 疾病管理;

关键词（英文）：

Atrial fibrillation; Anticoagulation; Direct oral anticoagulants; Embolism; Hemorrhage; Risk evaluation;Disease management

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.040

基金项目：

摘要：

研究显示，心房颤动可使缺血性卒中风险增加5倍，20%以上的卒中归因于心房颤动，且心房颤动所致卒中具有高致残率、高病死率及高复发率的特点，给患者家庭和社会带来沉重负担。抗凝治疗是心房颤动综合治疗中的重要环节，且目前全世界指南一致认为，心房颤动患者要优选直接口服抗凝药（DOAC）进行抗凝治疗。但抗凝治疗在减少心房颤动患者血栓栓塞风险的同时会增加其出血风险。本文阐述了心房颤动患者DOAC治疗新进展、心房颤动患者栓塞风险与抗凝治疗出血风险的评估、心房颤动患者抗凝治疗出血的风险管理及应对策略，希望能够为临床心房颤动患者的抗凝治疗提供借鉴。

英文摘要：

【Abstract】 Studies have shown that atrial fibrillation can increase the risk of ischemic stroke by 5 times, more than 20% of strokes are attributed to atrial fibrillation, and stroke caused by atrial fibrillation is characterized by high disability rate, high mortality rate and high recurrence rate, which brings a heavy burden to patients' families and society. Anticoagulant therapy is an important link in the comprehensive treatment of atrial fibrillation. At present, the guidelines all over the world agree that patients with atrial fibrillation should be treated with direct oral anticoagulants (DOAC) . However, anticoagulant therapy can reduce the risk of thromboembolism and increase the risk of bleeding in patients with atrial fibrillation. This article describes the new progress of DOAC treatment in patients with atrial fibrillation, the evaluation of embolism risk and anticoagulation therapy bleeding risk in patients with atrial fibrillation, the risk management and coping strategies of anticoagulation therapy bleeding in patients with atrial fibrillation, hoping to provide reference for anticoagulation treatment in patients with atrial fibrillation.

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