病例报告:新的并不总是更好:治疗非细菌性血栓性内心炎
Elias Akiki1, Ali Ahmad1,2, Edward A El-Am1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Frontiers in cardiovascular medicine
|July 28, 2023
概括
肝素是癌症患者非细菌性血栓性内心炎 (NBTE) 的首选抗凝剂. 从阿皮克萨班转换为低分子量肝素 (LMWH) 导致肺癌和心房动患者的NBTE解决.
科学领域:
- 心脏病学 心脏病学
- 在瘤学瘤学.
- 血液学 血液学 血液学
背景情况:
- 非细菌性血栓性内心炎 (NBTE) 是一种罕见但严重的并发症,特别是在患有恶性瘤的患者中.
- 在NBTE患者中,抗凝药非常重要,但最佳药物选择仍在争论中.
- 这个病例涉及一个患有转移性肺腺癌和心房的老年女性,在Apixaban上经历了栓塞性中风.
研究的目的:
- 评估低分子量肝素 (LMWH) 在治疗与恶性瘤相关的非细菌性血栓性内心炎 (NBTE) 的疗效.
- 要突出直接口服抗凝剂 (DOAC) 在复杂的血栓形成情景中的潜在局限性.
主要方法:
- 经食道回声心脏图 (TEE) 用于诊断和监测.
- 患者的抗凝药从阿皮克萨班转换为LMWH.
- 进行了临床和心声回声监测的随访.
主要成果:
- 最初使用阿皮克萨班的抗凝血药物未能预防栓塞事件.
- 测试显示了米特拉的NBTE.
- 切换到LMWH导致NBTE在后续TEE上完全解决.
结论:
- 在患有恶性瘤的患者中,肝,包括LMWH,应被认为是NBTE选择的抗凝剂.
- 像阿皮克萨班这样的DOAC可能不足以控制NBTE.
- 这一案例强调了针对复杂的瘤和心血管疾病的定制抗凝策略的重要性.
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