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附属体封闭期间的抗凝强度:从静音脑栓塞中吸取教训

Kexin Wang¹, Mingjia Xu¹, Zhe Wang¹

¹Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

|February 14, 2024

概括

在左心房尾闭塞 (LAAO) 期间将激活凝血时间 (ACT) 提高到300秒,可以在不增加出血的情况下降低静音脑栓塞 (SCE) 风险. 这一发现对于改善LAAO程序安全至关重要.

科学领域:

心脏病学心脏病学
神经学神经学
干预性放射学干预性放射学

背景情况:

血管内左心房附属物阻塞 (LAAO) 程序带有围绕程序静音脑栓塞 (SCE) 的高风险.
目前的专家共识建议LAAO的激活凝血时间 (ACT) 目标较低,而非心房动 (AF) 移除.
在LAAO期间最大限度地减少SCE的最佳ACT门仍然不清楚.

研究的目的:

调查LAAO期间提高目标ACT水平以符合AF消除指南 (≥300秒) 是否可以降低SCE的发生率.
在LAAO程序中评估更高ACT目标的安全性和有效性.

主要方法:

一项前性观察队列研究,涉及连续接受LAAO的AF患者.
患者被分为两组:一个目标ACT≥250秒 (组250) 和另一个目标ACT≥300秒 (组300).
在LAAO之前和之后进行脑磁共振成像,以检测SCE.

主要成果:

在治疗权重的逆概率 (IPTW) 后,250组 (较低的ACT目标) 与300组 (较高的ACT目标) 相比,SCE发病率显著更高 (IPTW p = 0.038).
一个稳定的高ACT模式与SCE风险降低有关.
没有观察到与其他ACT变化模式的SCE发病率有显著差异.

结论:

在LAAO期间保持≥300s的稳定的术前ACT可以降低SCE的风险.
这种更高的ACT目标并没有导致重大出血事件的增加.
在LAAO期间优化ACT管理是提高患者安全的可行策略.

关键词:

激活的凝血时间心房动和中风的发生.左心房附属体封闭的情况沉默的脑栓塞是什么意思

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