在心房动中挑战抗凝决定:叙述性综述
Michael Griffin1, Riccardo Proietti2, Gregory Y H Lip2,3
1Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.
Therapeutic advances in cardiovascular disease
|October 16, 2024
概括
口服抗凝剂 (OAC) 药物治疗心房 (AF) 的决定在亚临床病例或二次AF中可能是复杂的. 本综述为管理这些具有挑战性的临床场景提供了实际指导.
科学领域:
- 心脏病学 心脏病学
- 临床医学 临床医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 心房动 (AF) 很普遍,往往需要口服抗凝剂 (OAC) 治疗.
- 标准指南涉及临床AF,但对亚临床AF和二次AF的证据有限.
- 亚临床AF和二次AF对OAC决策提出了独特的挑战.
研究的目的:
- 审查关于OAC在特定心房 (AF) 背景下使用的文献.
- 为管理亚临床和二级AF的临床医生提供实用建议.
- 在缺血性中风后和在外科外科设置中解决OAC决策.
主要方法:
- 现有文献的叙述性审查.
- 综合有关OAC在特定AF场景中的好处和风险的证据.
- 对观察数据和最近随机对照试验的分析.
主要成果:
- 亚临床AF带有中风风险,但OAC的益处可能低于临床AF;较长的发作更重要.
- 缺少因败血症或非心脏手术引发的AF中OAC的证据,临床实践是不同的.
- 缺血性中风后早期的OAC重新启动是安全的和建议的;由于出血风险,心脏手术后的OAC使用通常是禁忌的.
结论:
- 在AF抗凝治疗中的临床困境需要仔细考虑标准指南之外的情况.
- 亚临床AF,二次AF和中风后场景需要量身定制的OAC策略.
- 本综述为临床医生提供了基于证据的建议,用于AF中复杂的OAC管理.
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