在患有左心室血栓的患者中,抗凝固的最佳持续时间是多少?
Fang Qin Goh1, Ching-Hui Sia2,3, Mark Y Chan2,3
1Department of Medicine, National University Hospital, National University Health System, Singapore.
Expert review of cardiovascular therapy
|October 13, 2023
概括
在左心室血栓 (LVT) 中,抗凝固治疗的最佳持续时间尚不清楚. 需要进一步的研究来指导治疗决策,并尽量减少中风或出血的风险.
科学领域:
- 心脏病学 心脏病学
- 心血管成像 - 心血管成像
- 血栓形成的管理
背景情况:
- 左心室血栓 (LVT) 是心肌梗塞和心肌病变的并发症,具有栓塞性中风的风险.
- 目前的指导方针建议在LVT治疗中服用3-6个月的抗凝药,但证据有限.
- 由于长期治疗的出血风险和早期停止的栓塞风险,最优的持续时间仍在争论中.
研究的目的:
- 审查目前关于LVT抗凝剂持续时间的建议和专家意见.
- 突出心脏磁共振成像 (CMR) 在指导治疗决策中的作用.
- 确定在LVT管理中未来研究的领域.
主要方法:
- 审查现有的指导方针和专家共识声明.
- 讨论心声回声学与CMR在LVT检测中的诊断效用.
- 对影响长期抗凝药决定因素的分析.
主要成果:
- 没有随机试验存在于LVT抗凝药持续时间.
- 专家的共识建议3-6个月的抗凝药,在血栓解决后停止.
- 对于LVT来说,CMR比心声回声更敏感,可以指导监测.
- 对于持续性,移动性或突起性LVT,或对LVT功能受损的患者,可以考虑长期使用抗凝药.
结论:
- 心脏磁共振成像 (CMR) 正在成为LVT监测的关键工具,以指导抗凝.
- 进一步的研究是必要的,以确定长时间抗凝剂在特定的LVT患者亚组的好处.
- 需要个性化治疗策略来平衡栓塞风险和出血并发症.
相关概念视频
Venous Thrombosis III: Interprofessional Care
10
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
10
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
10
Anticoagulant Drugs: Low-Molecular-Weight Heparins
726
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
726
Venous Thrombosis IV: Nursing Management
14
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
14
Pulmonary Embolism III: Nursing Management
15
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
15
Acute Coronary Syndrome IV: Interprofessional Care
11
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
11


