对于心房的消去后的左心房尾关闭
Oussama M Wazni1, Walid I Saliba1, Devi G Nair2
1Cleveland Clinic, Cleveland.
The New England journal of medicine
|November 18, 2024
概括
与心房缩后的口服抗凝药相比,左心房尾关闭显著减少了出血事件. 这种基于设备的治疗方法在预防中风和栓塞方面被证明是非劣质的,为高风险患者提供了更安全的替代方案.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械 医疗器械
背景情况:
- 口服抗凝药是用于中风风险的标准心房后消化药.
- 左心房尾关闭 (LAAC) 提供了一种机械替代方案,但经过切除后的数据有限.
研究的目的:
- 为了比较LAAC与口服抗凝药 (OAC) 的安全性和有效性,在接受心房移除的患者中.
- 评估LAAC作为OAC的替代方案,以预防这一群体中风.
主要方法:
- 国际随机试验包括1600名患有心房和高CHA2DS2-VASc分数的患者,接受了导管切除.
- 患者被随机分为1:1的LAAC或OAC.
- 主要安全终点:与程序无关的重大或临床相关的非重大出血 (优越性). 主要疗效终点:死亡,中风或全身血栓塞 (非劣质) 的组合.
主要成果:
- 在LAAC组 (803名患者) 中,相比OAC组 (797名患者,18.1%;P<0.001),主要安全事件显著降低 (8.5%).
- 在初级疗效终点 (5.3%对5.8%;P<0.001) 中,LAAC与OAC没有劣势.
- 与LAAC相关的并发症发生在23名患者身上.
结论:
- 左心房尾关闭比口服抗凝药对心房移除后的出血更安全.
- 拉克是一种非劣质的替代口服抗凝药,用于预防中风,死亡或全身血栓塞在患者的移除后.
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