脑卒中和最近的心肌梗塞,左心室射出小部分减少,左心室血栓和壁运动异常
Ana Catarina Fonseca1,2,3
1Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1640-035, Lisboa, Portugal. acfonseca@medicina.ulisboa.pt.
对于左心室血栓,建议在抗血小板治疗上使用抗凝剂,以预防缺血性中风. 缺乏证据表明,在减少喷射分数或墙壁运动异常的患者中,抗凝效果有好处.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 血管医学 血管医学
背景情况:
- 心肌梗塞 (MI) 和相关的心脏疾病增加中风风险.
- 重灌疗法降低了心脏病发作后中风风险.
- 在特定的心脏病患者群体中,中风仍然是一个问题.
研究的目的:
- 审查最近心脏病发作,减少喷射分数,左心室血栓 (LVT) 和壁运动异常 (WMA) 的患者中风预防的证据.
- 评估当前的治疗策略,并确定证据缺口.
主要方法:
- 对现有文献进行系统审查.
- 对抗凝血治疗与预防中风的抗血小板治疗研究的分析.
- 在近期心脏病发作背景下对中风治疗选择的评估.
主要成果:
- 抗凝药对已确定的LVT优于抗血小板治疗,推持续时间为3-6个月.
- 没有证据支持抗凝药对抗血小板治疗用于预防中风的低射出分数或WMA的患者.
- 在最近的心脏病发作患者中,中风治疗决策 (血栓溶解,血栓切除) 需要考虑心脏病发作的类型,时间和位置.
结论:
- 抗凝血是已建立的LVT中风预防的首选策略.
- 需要进一步进行高质量的研究,以指导降低射出分数或MI后WMA患者的中风预防.
- 目前关于预防这些心脏疾病中风的指导方针主要基于专家意见.
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