Revista Espanola de Cardiologia Suplementos最新文献_第9页

Escalas de evaluación del riesgo tromboembólico y hemorrágico en la fibrilación auricular 评估房颤血栓栓塞和出血性风险的量表

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30011-5

Javier Pérez-Copete , María Asunción Esteve-Pastor , Vanessa Roldán , Mariano Valdés , Francisco Marín

{"title":"Escalas de evaluación del riesgo tromboembólico y hemorrágico en la fibrilación auricular","authors":"Javier Pérez-Copete , María Asunción Esteve-Pastor , Vanessa Roldán , Mariano Valdés , Francisco Marín","doi":"10.1016/S1131-3587(16)30011-5","DOIUrl":"10.1016/S1131-3587(16)30011-5","url":null,"abstract":"<div><p>Atrial fibrillation is the most prevalent cardiac arrhythmia in the general population. Its presence increases the risk of thromboembolic events five-fold. Antithrombotic therapy reduces this risk, but increases the risk of bleeding, with intracranial bleeding being the most feared complication. However, the risk varies between patients and, as a result, various thromboembolic risk scores have been developed in recent years (e.g. the CHADS<sub>2</sub>, CHA<sub>2</sub>DS<sub>2</sub>-VASc and ATRIA scores). The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is recommended by clinical practice guidelines to help optimize antithrombotic therapy in patients with atrial fibrillation. In addition, these guidelines also recommend that both thromboembolic risk and the risk of bleeding should be assessed. A number of risk models have been proposed for assessing the bleeding risk in these patients (e.g. the HEMORR<sub>2</sub>HAGES, HAS-BLED, ATRIA and ORBIT-AF scores), but currently the majority of guidelines recommend the HAS-BLED score. Above all, it is essential that the net clinical benefit of antithrombotic therapy is assessed: the expected benefit of anticoagulation therapy should outweigh the expected harm caused by possible bleeding. Nevertheless, the ability of both thromboembolic and bleeding risk scores to predict clinical events is only moderate. Consequently, alternative approaches, such as the use of biomarkers (e.g. D-dimer, von Willebrand factor and GDF-15), could help evaluate the thromboembolic risk in individual patients with atrial fibrillation.</p></div>","PeriodicalId":34926,"journal":{"name":"Revista Espanola de Cardiologia Suplementos","volume":"16 ","pages":"Pages 25-32"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1131-3587(16)30011-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56633720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Tratamiento no farmacológico de la fibrilación auricular. Ablación, cardioversión eléctrica, marcapasos y cierre de la orejuela 心房颤动的非药物治疗。消融，电转位，起搏器和枕骨闭合

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30013-9

Felipe Atienza , Ángel Moya

引用次数: 2

Acceso a los anticoagulantes de acción directa en España 在西班牙获得直接作用抗凝剂

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30016-4

José Luis Segú

{"title":"Acceso a los anticoagulantes de acción directa en España","authors":"José Luis Segú","doi":"10.1016/S1131-3587(16)30016-4","DOIUrl":"10.1016/S1131-3587(16)30016-4","url":null,"abstract":"<div><p>In Spain, new oral anticoagulants are used in fewer than 20% of patients with nonvalvular atrial fibrillation. This is lower than the rate observed in comparable countries and lower than that expected given current official recommendations and given the number of patients known to lie outside the therapeutic range while taking vitamin-K antagonists. This article provides an overview of the possible causes of the apparently low use of new oral anticoagulants in Spain. A number of distinct barriers have been documented that affect individuals involved in treatment decision-making (i.e. patients and health-care professionals and payers). The most relevant explanatory factors appear to be resistance to change by patients and health-care professionals, prescription being restricted to particular specialists, and the variation in policies affecting access to drugs between different Spanish autonomous regions. The causative factor that appears to best explain differing access to new oral anticoagulants in the Spanish National Health System is the impact of these drugs on the health budget. In particular, difficulties have been created by the absence of a coherent common management framework that takes responsibility for both the decision to fund an innovative treatment and the budgetary implications of its use. The effectiveness of a particular type of therapy does not imply that it will be “possible” to fund it at any given time, given that it is always legitimate to limit its use if decision-making is transparent and based on clear criteria. However, keeping alive, mostly nonexistent, technical uncertainties does not help solve the problem and casts doubt on the credibility of the evaluation process.</p></div>","PeriodicalId":34926,"journal":{"name":"Revista Espanola de Cardiologia Suplementos","volume":"16 ","pages":"Pages 55-59"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1131-3587(16)30016-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56633923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Introducción 导言

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30006-1

Luis Rodríguez Padial

引用次数: 0

Epidemiología de la fibrilación auricular 心房颤动的流行病学

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30007-3

Juan José Gómez-Doblas , Miguel Antonio López-Garrido , Iris Esteve-Ruiz , Gonzalo Barón-Esquivias

引用次数: 11

Tratamiento farmacológico de la fibrilación auricular. Antiarrítmicos y anticoagulantes orales 心房颤动的药物治疗。口服抗心律失常和抗凝药物

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30012-7

Juan Cosin-Sales , Juan José Olalla

引用次数: 1

Desarrollo clínico del edoxabán. Estudios en fase II edoxaban的临床发展。第二阶段研究

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30018-8

Manuel Almendro-Delia, Rafael Hidalgo-Urbano

引用次数: 0

Mecanismos electrofisiológicos y diagnóstico de la fibrilación auricular 心房颤动的电生理机制及诊断

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30009-7

Jose Luis Merino

{"title":"Mecanismos electrofisiológicos y diagnóstico de la fibrilación auricular","authors":"Jose Luis Merino","doi":"10.1016/S1131-3587(16)30009-7","DOIUrl":"10.1016/S1131-3587(16)30009-7","url":null,"abstract":"<div><p>Despite being the most common sustained cardiac arrhythmia and despite having been first described over 100 years ago, atrial fibrillation is, like ventricular fibrillation, virtually the only arrhythmia whose mechanism is still unknown. This lack of knowledge has profound clinical implications and is not just of academic interest. Firstly, lack of knowledge means that the diagnosis of atrial fibrillation is still based on ECG findings, which can often give rise to doubts about the diagnosis, with both surface ECGs and intracardiac electrophysiological studies. Moreover, lack of knowledge about the underlying mechanism also hampers the development of both better-targeted pharmacological and invasive therapies and preventive measures that can avert, or at least delay, the onset of atrial fibrillation. This article provides a review of the most widely accepted theories about the mechanism underlying this arrhythmia, such as the multiple coexisting functional re-entry circuits theory and the mother rotor theory. In addition, the article examines factors that could influence the condition, such as atrial remodeling, atrial fibrosis and scarring, and the critical atrial mass, and considers the role of the pulmonary veins and the evidence supporting a link with re-entry. Diagnostic criteria for this arrhythmia, its classification and recommended diagnostic investigations are also discussed.</p></div>","PeriodicalId":34926,"journal":{"name":"Revista Espanola de Cardiologia Suplementos","volume":"16 ","pages":"Pages 12-19"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1131-3587(16)30009-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56633578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

La fibrilación auricular en las guías de práctica clínica 临床实践指南中的心房颤动

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30015-2

José Luis Zamorano

引用次数: 3

Etiología y prevención de la fibrilación auricular 心房颤动的病因及预防

Revista Espanola de Cardiologia Suplementos Pub Date : 2016-01-01 DOI: 10.1016/S1131-3587(16)30008-5

Domingo Marzal Martín , Luis Rodríguez Padial

引用次数: 1