在缺血性中风后,尽管使用抗凝药,左心室尾的封闭与护理标准相比
Moniek Maarse1,2, David J Seiffge3, David J Werring4
1Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands.
JAMA neurology
|October 7, 2024
概括
左心房尾阻塞 (LAAO) 在心房的患者中显著降低了缺血性中风风险,这些患者尽管接受了口服抗凝治疗 (OAT),但却经历了中风. 拉奥提供了一个有前途的替代性中风预防策略.
科学领域:
- 心血管医学 心血管医学
- 神经学 神经学
- 干预心脏病学 干预心脏病学
背景情况:
- 在接受口服抗凝疗 (OAT) 期间经历缺血性中风的心房动 (AF) 患者面临高复发风险.
- 左心房尾闭塞 (LAAO) 是一种机械性中风预防策略,可以在这些高危人群中增加保护.
研究的目的:
- 为了比较皮LAAO与单独持续OAT在预防复发性缺血性中风的疗效.
- 评估LAAO作为一种替代性中风预防策略,用于患有AF和血栓塞栓事件的患者,尽管OAT.
主要方法:
- 一项倾向分数匹配的队列研究,将接受LAAO (STR-OAC LAAO队列) 的患者与仅继续OAT的对照组进行比较.
- 该研究包括433名LAAO患者与来自国际前性注册和研究的433名对照患者进行匹配.
- 主要结局是第一个缺血性中风的时间,随访时间中位数超过3个月.
主要成果:
- 与单独服用OAT的组 (8.9%) 相比,LAAO组的年化缺血性中风发生率显著降低 (2.8%).
- LAAO与67%的缺血性中风风险降低有关 (危险比率,0.33;95% CI,0.19-0.58;P <.001).
- 在LAAO后67%的患者中断了OAT,而33%的患者继续使用OAT作为辅助治疗.
结论:
- 在高风险的AF患者中,与继续单独服用口服抗凝药疗法相比,左心房尾封闭与缺血性中风的风险显著降低.
- 尽管有OAT,LAAO在非膜AF患者和血栓栓塞事件史患者中显示出作为预防中风的治疗选择的希望.
- 需要进一步的随机临床试验数据来证实这些发现,并确定LAAO作为最终的治疗方法.
相关概念视频
Venous Thrombosis III: Interprofessional Care
3
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...
3
Anticoagulant Drugs: Low-Molecular-Weight Heparins
636
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...
636
Acute Coronary Syndrome IV: Interprofessional Care
3
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...
3
Aneurysm III: Interprofessional Care
3
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
3
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K


