直接口服抗凝剂在心房与中风中的失败:回顾性入院分析和新型分类系统
David Z Rose1, Jane Y Chang2, Xiyan Yi3
1Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
The Neurohospitalist
|July 13, 2023
概括
直接口服抗凝剂 (DOAC) 经常被处方给心房动 (AF) 患者. 在突破性急性缺血性中风 (AIS) 的情况下,其他原因如合规问题或其他条件比DOAC故障更有可能发生.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在接受直接口服抗凝剂 (DOACs) 的非膜性心房动 (AF) 患者中,急性缺血性中风 (AIS) 提出了临床挑战.
- 切换抗凝剂在预防复发性AIS方面没有被证明是有效的.
- 了解"DOAC故障"的原因对于患者管理至关重要.
研究的目的:
- 在已知AF的患者中研究AIS的替代病因,这些患者被处方DOACs.
- 引入和应用一个新的分类方案 (CLAMP) 来分类DOAC故障.
- 要区分DOAC"伪失败"和"加密失败".
主要方法:
- 一项对AIS患者入院的六年回顾性研究规定了AF的DOAC.
- 使用了CLAMP方案:合规性,缺陷,动脉病变,恶性病变,形孔.
- 在DOAC子组进行了前后勤回归分析.
主要成果:
- 在4890名AIS患者中,87名患者接受了AF的DOAC治疗,导致DOAC失败率为14.4%.
- DOAC"伪失败" (鉴定了其他原因) 占77%的病例.
- 合规问题 (48.9%) 和恶性病 (26.1%) 是最常见的伪失败. 加密失败与较低的CHADSVASc分数有关,并且与里瓦洛克萨班更频繁.
结论:
- 在AIS患有AF的DOAC患者中,已识别的替代病因 (伪失败) 比真正的DOAC失败 (加密失败) 明显更为常见.
- CLAMP 方案提供了一种结构化的方法,用于在 DOAC 上诊断和管理 AF 患者的 AIS.
- 这种分类有助于识别除了抗凝血不足之外的特定原因.
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