Atrial Fibrillation心房顫動
----- 最近(2009-Mar)
ADA提醒醫師们, 注意使用抗凝血劑, 心房纖維顫動患者的牙科治療
Pathogenesis, Medical-Surgical Management and Dental Implications.
Arthur H. Friedlander, et al. J Am Dent Assoc, 2009; Vol 140, No 2, 167-177.
Background. Atrial fibrillation (AF) is a cardiac rhythm disturbance arising from disorganized electrical activity in the atria, and it is accompanied by an irregular and often rapid ventricular response. It is the most common clinically significant dysrhythmia in the general and older population.
Types of Studies Reviewed. The authors conducted a MEDLINE search using the key terms "atrial fibrillation," "epidemiology," "pathophysiology," "treatment" and "dentistry." They selected contemporaneous articles published in peer-reviewed journals and gave preference to articles reporting randomized controlled trials.
Clinical Implications. The anticoagulant warfarin frequently is prescribed to prevent stroke caused by cardiogenic thromboemboli arising from stagnant blood in poorly contracting atria. Most dental procedures and a limited number of surgical procedures can be performed without altering warfarin dosage if the international normalized ratio value is within the therapeutic range of 2.0 to 3.0. Certain analgesic agents, antibiotic agents, antifungal agents and sedative hypnotics, however, should not be prescribed without consultation with the patient’s physician because these medications may alter the patient’s risk of hemorrhage and stroke.
Conclusions. AF affects nearly 2.5 million Americans, most of who are older than 60 years. Consultation with the patient’s physician to discuss the planned dental treatment often is appropriate, especially for people who frequently have comorbid diseases such as coronary artery disease, congestive heart failure, diabetes and thyrotoxicosis, which are treated with multiple drug regimens.
Key Words: Cardiovascular diseases; stroke; anticoagulation therapy
Abbreviations: ADA CSA: American Dental Association Council on Scientific Affairs. • AHA: American Heart Association. • AF: Atrial fibrillation. • ASA: Acetylsalicylic acid. • AV: Atrioventricular. • ECG: Electrocardiogram. • INR: International normalized ratio. • LMWH: Low-molecular-weight heparin. • NSAID: Nonsteroidal anti-inflammatory drug. • PV: Pulmonary veins. • SA: Sinoatrial.
PS
.心房纖維顫動的主要治療目標之ㄧ是預防中風。
從1989年至1993年有六個大型臨床實驗證實warfarin可以降低心房纖維顫動之中風危險性達62%。
心臟衰竭和曾發生缺血性中風或暫時性腦部缺血發作，是比較會使用warfarin。
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預防 |
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要預防心房顫動發生並維持心臟的健康，最好的方法請遵循以下步驟；包括：
很遺憾的是，可能無法完全預防心房顫動，且可能需要長期治療此種狀況。 | |
-- 可參考網頁
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