The cardiac circuit is a hidden project, and the transmission line buried in the myocardial wall is called "cardiac conduction system". Their supreme commander is called sinoatrial node, which is located in a small myocardial wall at the upper right of the right atrium. Sinus node sends out 60- 100 pulses per minute, and these electrical signals are transmitted to the whole myocardium in turn through transmission lines in the myocardial wall, causing the heart to beat. If there is something wrong with the circuit, arrhythmia will occur. There are many kinds of arrhythmia, for example, the nerve-like discharge of a certain part of the circuit and the fibrillation of the electric atrium are called atrial fibrillation.
Atrial fibrillation is one of the most common arrhythmias in clinic, accounting for about 15% of all arrhythmias. Atrial fibrillation can cause many complications and cause serious harm. Among them, stroke is the most serious complication of atrial fibrillation, because the stroke caused by atrial fibrillation has high medical expenses, high disability rate and high mortality rate.
Studies have shown that anticoagulant therapy can significantly reduce the new onset and recurrence of stroke in patients with atrial fibrillation, and it is an effective treatment to prevent stroke in patients with atrial fibrillation. Reasonable anticoagulant therapy can reduce fatal and disabling stroke by 62% and total stroke by 66%.
Not all patients with atrial fibrillation need to take anticoagulants, but people at high risk of stroke need to take anticoagulants for a long time. The risk of stroke in patients with atrial fibrillation is related to its risk factors, but not to the severity of symptoms. Therefore, the severity of atrial fibrillation symptoms is not a sign of starting or stopping anticoagulation.
The risk assessment methods of stroke in atrial fibrillation are as follows: heart failure is1; Hypertension1; 75 years old, 1 min; Diabetes1; Deduct 2 points for previous stroke or transient ischemic attack. If the score is 2, patients with atrial fibrillation without anticoagulation contraindications should take anticoagulants orally for a long time to prevent stroke and thromboembolism complications.
There are two kinds of anticoagulants commonly used in patients with atrial fibrillation: warfarin and new oral anticoagulants. It should be pointed out that antiplatelet drugs such as aspirin and clopidogrel are not as effective as anticoagulant therapy in preventing stroke caused by atrial fibrillation, so the guidelines suggest that anticoagulant drugs should be given priority over antiplatelet drugs.
Taking warfarin is complicated. Patients need to draw blood frequently to monitor INR and adjust the dosage of warfarin according to INR. Because only by controlling INR at 2~3 can we ensure both anticoagulant effect and medication safety. INR 2, anticoagulant effect is not enough, INR 3, bleeding risk is obviously increased. Dose should be adjusted individually according to INR value.
Generally speaking, INR is monitored 2-3 days after taking warfarin for the first time, then 1 time every week before INR is stabilized, 1 time every two weeks after INR is stabilized, and 1 time every month after stability. If the dose needs to be adjusted, it is necessary to repeat the above detection frequency until INR is stable again.
The curative effect of warfarin is influenced by food and drugs. Warfarin is a vitamin K antagonist, and its anticoagulant effect is affected by diet. Foods rich in vitamin K will reduce the efficacy of warfarin. Some foods will enhance the efficacy of warfarin, thus increasing the risk of bleeding. Therefore, you should maintain a relatively balanced diet while taking warfarin. Many drugs can also affect the efficacy of warfarin. Therefore, during the period of taking warfarin, the combined use of drugs should be minimized. If other drugs must be combined, you should inform your doctor in advance and ask if you need to adjust the drugs or strengthen monitoring.
A variety of foods and drugs have an effect on the efficacy of warfarin. In terms of diet, mango, garlic and grapefruit enhance the curative effect of warfarin. Weakening the curative effect of warfarin are: cod liver oil, beans, egg yolk, carrots, cauliflower, tomatoes, spinach, rape, lettuce and other green vegetables, apples, pears. In medicine, aspirin, cephalosporin, metronidazole, chloramphenicol, erythromycin and acetaminophen can enhance the curative effect of warfarin. Phenytoin sodium, barbiturates, oral contraceptives, estrogen, rifampicin and vitamin K will weaken the effect of warfarin.
Warfarin has anti-vitamin K effect in vivo, inhibiting the carboxylation of osteocalcin, reducing the deposition of bone calcium and inhibiting bone mineralization, thus interfering with bone metabolism and leading to osteoporosis or fracture, especially for elderly patients. The risk of osteoporosis caused by long-term use of warfarin may be related to dose and time.
This new oral medicine has many advantages and overcomes the shortcomings of warfarin. Including good curative effect, high safety, reducing intracranial hemorrhage, less interaction between drugs and food, convenient use, no need to monitor INR, and fixed dose administration.
If you are taking new oral anticoagulants, you need to visit regularly to monitor the changes of liver and kidney function. The main reason is that the dosage of anticoagulant drugs needs to be adjusted according to the function of liver and kidney. The frequency of monitoring depends on your basic liver and kidney function level and other health conditions.
If combined with other diseases (such as coronary heart disease, digestive tract diseases, etc.). ) and need to be combined with other drugs, such as aspirin, clopidogrel, Tigray, etc., you should communicate with your doctor in time so that the doctor can make the best treatment choice.
The main side effect of anticoagulants is the risk of bleeding. Therefore, before taking anticoagulant drugs, it is necessary to do blood risk assessment, pay attention to screening and correcting the reversible factors that increase the risk of bleeding, and start anticoagulant therapy at the right time. Pay attention to bleeding when taking anticoagulant drugs. If there are adverse reactions such as bleeding or new changes in your condition, you should inform the doctor in time so that the doctor can comprehensively evaluate your situation and decide the next treatment strategy.
No need to deal with it: for small bleeding, such as gingival bleeding when brushing teeth, it is easy to have bruises or bleeding spots after skin bumps, and it can be ignored, which generally has little effect.
Need to see a doctor: in case of bleeding (hematuria, black stool) or sudden headache, nausea, vomiting, dizziness, etc. The harm is serious and you need to see a doctor at once.
Generally speaking, the advantages of taking oral anticoagulants outweigh the disadvantages, and safe and reasonable anticoagulation therapy can effectively reduce the occurrence of adverse events.
Missing warfarin: Missing 1 day is not a big problem, please handle it according to the following principles. If you miss 4 hours, you will be on standby; If you miss taking it for more than 4 hours, please don't take it again and continue taking it normally the next day. You can't take medicine twice the next day just because you forgot to eat it. If you miss warfarin one day, you can add half a tablet the next day and return to normal on the third day.
New oral anticoagulant missed: once a day within 12 hours, twice a day within 6 hours, and the previous missed dose should be supplemented. If it exceeds the above time limit, it will not be taken, and it will still be taken at the original dose after 1 time. Don't double it If you forget whether you have taken 1 time a day, you should take 1 time immediately, and then take it at the prescribed time and dose. Take the medicine twice a day on time and in quantity next time.
Excessive anticoagulation can lead to hematuria, hematochezia, intracranial hemorrhage, subcutaneous hemorrhage, gingival hemorrhage, nosebleed and other complications. If you take too much anticoagulant, you need to go to the hospital immediately, so as to closely observe whether there is bleeding, reduce or stop anticoagulants in time, and use antagonists if necessary.
Anticoagulant therapy needs long-term persistence, and withdrawal and interruption of treatment will significantly increase the risk of stroke. Atrial fibrillation is a chronic disease, and patients with high risk of stroke generally need to adhere to long-term anticoagulant therapy. The new oral anticoagulant does not need routine monitoring of coagulation function during treatment, which is more convenient for long-term treatment.
Through follow-up, doctors can know the patient's medication and the changes of his condition in time, so as to accurately evaluate and adjust the treatment plan and ensure the continuous optimal treatment.