Interpretation and consideration of 2024 ESC Guideline for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
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摘要: 本文纵向比较《2024 ESC/EACTS心房颤动管理指南》的核心与特点，对2024指南提出的AF-CARE路径进行解读和分析。凝炼了CARE各部分如合并症和风险因素管理、预防卒中和血栓栓塞、控制心率和节律减轻症状、评价和动态评估的更新要点，以指导临床实践。明确2024指南中亟待解决的几个问题，对未来心房颤动循证医学研究有启示作用。Abstract: This paper compares the core and characteristics of 2024 ESC Guideline for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) longitudinally, and interprets the AF-CARE path proposed from the guideline. The updated points of four parts of CARE, such as comorbidity and risk factor management, avoid stroke and thromboembolism, reduce symptoms by rate and rhythm control, evaluation and dynamic reassessment, are condensed to guide clinical practice. The guideline clarified some problems that would be solved urgently, which enlightened the future researches based on evidence in atrial fibrillation.
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Key words:
- atrial fibrillation /
- guideline /
- European Society of Cardiology
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表 1 4种新型抗凝剂的使用
Table 1. Use of 4 kinds of new anticoagulants
药物种类 标准全剂量 减量标准 减量后剂量 阿哌沙班 5 mg, bid 符合下述3项中2项：①年龄≥80岁；②体重≤60 kg；③血肌酐≥133 μmol/L 2.5 mg, bid 达比加群酯 150 mg, bid 满足下列任1项：①年龄≥80岁；②正在服用维拉帕米。下列情况可酌情减量：①年龄75~80岁；②中度肾功能不全(肌酐清除率30~50 mL/min)；③合并胃炎、食管炎，或胃食管反流病；④其他高出血风险 110 mg, bid 艾多沙班 60 mg, qd 满足下列任一项：①中重度肾功能不全(肌酐清除率15~50 mL/min)；②体重≤60 kg；③正在服用环孢素、决奈达隆、红霉素或酮康唑 30 mg, qd 利伐沙班 20 mg, qd 肌酐清除率15~49 mL/min 15 mg, qd 
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[1] Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS)[J]. Eur Heart J, 2024, Aug 30: ehae176. doi: 10.1093/eurheartj/ehae176.
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