血栓栓塞的特征和抗凝剂在长期Fontan循环中的作用
Mechthild Westhoff-Bleck1, Carolin Klages1, Carolin Zwadlo1
1Department of Cardiology and Angiology, Adult Congenital Heart Disease Centre Hannover, Hannover Medical School, Hannover, Germany.
International journal of cardiology. Congenital heart disease
|December 23, 2024
概括
维生素K对抗剂 (VKA) 显著降低了长期Fontan循环的患者血栓栓塞的风险,与没有治疗或乙盐酸 (ASA) 相比. 维卡提供最好的净益,平衡血栓栓塞事件和出血并发症.
科学领域:
- 心脏病学 心脏病学
- 儿童心脏病学 儿童心脏病学
- 心血管外科心血管外科
背景情况:
- 血栓塞栓的风险随着Fontan循环持续时间的增加而升级.
- 在Fontan患者中预防血栓栓塞的药理学策略仍然是争论的主题.
研究的目的:
- 调查长期Fontan循环的成年人中临床相关的血栓栓塞事件的发生率.
- 评估乙盐酸 (ASA) 和维生素K对抗剂 (VKA) 在预防血栓栓塞的比较有效性.
主要方法:
- 一组78名患有Fontan循环的成年患者 (年龄≥16岁) 被追溯分析.
- 收集了药物,Fontan循环的持续时间和血栓栓塞事件的数据;术后事件被排除在外.
主要成果:
- 15名患者 (19.2%) 经历了血栓栓塞事件,包括深静脉血栓,肺栓塞和脑栓塞.
- 长时间的Fontan循环与更高的血栓栓塞的风险相关 (p < 0.001).
- 与没有治疗 (OR 10.2) 或ASA (OR 1.25) 相比,维生素K对抗剂 (VKA) 显示血栓栓塞的风险明显降低 (OR 0.17). 此外,VKA在血栓栓塞和出血并发症 (11.4%) 方面也显示出最佳的净益率.
结论:
- 用VKA进行抗凝血治疗是预防Fontan循环患者晚期血栓栓塞事件的安全有效策略.
- 深静脉血栓和心内血栓的形成,通常与脑膜上下心动 (SVT) 相关,是这一群体的主要关注点.
- 与ASA或没有抗血栓治疗相比,VKA治疗提供了对血栓栓塞的优越保护,并且具有更好的整体风险-益处概况.
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