关闭左耳垂后与设备相关的血栓:发生率,预测因素和结果
Srinivas R Dukkipati1, Saibal Kar2, David R Holmes3
1Icahn School of Medicine at Mount Sinai, New York, NY (S.R.D., V.Y.R.).
Circulation
|May 13, 2018
概括
在Watchman左心房关闭后,大约3. 7%的患者出现了与设备相关的血栓 (DRT). 虽然DRT很少发生,但它显著增加了中风和全身栓塞的风险,因此需要仔细监测.
科学领域:
- 心脏病学
- 医疗器械
- 血栓形成研究
背景情况:
- 用Watchman装置关闭左心房的心房动患者有与装置相关的血栓 (DRT) 的风险.
- 在Watchman装置上形成DRT可能会导致血栓塞栓事件.
- 了解DRT发生率,预测因素和结果对于患者管理至关重要.
研究的目的:
- 调查器件相关血栓 (DRT) 的发生率,预测因素和临床结果.
- 在多个临床试验中对接受Watchman植入的患者进行DRT分析.
- 评估DRT与术后中风或全身栓塞 (SSE) 之间的关联.
主要方法:
- 包括PROTECT- AF,PREVAIL,CAP和CAP2在内的4项前性食品和药物管理局 (FDA) 试验的分析
- 在植入后45天,6个月和12个月进行的监测透食心电图.
- 根据CHA2DS2-VASC和HAS-BLED得分进行调整的DRT发生率和临床结果 (SSE) 的评估.
主要成果:
- 在1739名患者中,DRT被观察到3. 74%,与没有DRT的患者相比,SSE的发生率更高 (每100个患者年7. 46).
- 预测DRT的因素包括过渡性缺血性发作或中风,永久性心房动,血管疾病,左心房附属体直径更大,左下心室射出分数.
- 在26. 2%的DRT患者中,DRT和SSE同时发生,其中很大一部分SSE事件发生在DRT检测后6个月内.
结论:
- 在Watchman植入后,与器件相关的血栓发生在约3. 7%的患者中.
- 药物治疗与中风和全身栓塞的风险显著增加有关.
- 虽然DRT不常见,但由于与不良血栓栓事件相关,需要仔细考虑.
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