间断与不间断的抗凝剂用于心律控制装置插入心律管理装置
Brett Chen1, Mi Phan2, Vinay Pasupuleti3
1Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA.
The Cochrane database of systematic reviews
|January 28, 2025
概括
在心脏植入式电子器件 (CIED) 手术中断抗凝剂的结果与持续抗凝剂的结果相似. 需要进一步的研究来证实对血栓塞栓事件和设备口袋血瘤风险的影响.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗器械 医疗器械
背景情况:
- 在心脏植入式电子设备 (CIED) 手术期间进行外科手术期间的抗凝中断策略在全球范围内有所不同.
- 关于CIED手术中中断或不间断的抗凝剂的益处和危害存在不确定性.
研究的目的:
- 在接受CIED手术的患者中,评估中断抗凝剂 (IAC) 与不间断抗凝剂 (UAC) 的益处和危害.
- 为了将IAC与华法林或直接口服抗凝剂 (DOAC) 与UAC进行比较,有或没有氨酸桥接.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析.
- 包括的研究比较了在接受华法林或DOAC选择性CIED手术的成年人中的IAC与UAC.
- 主要结局包括复合性血栓栓塞事件和设备口袋血瘤;次要结局包括出血事件和死亡率.
主要成果:
- 对于华法林,IAC在复合血栓栓塞事件 (低确定性证据) 中几乎没有差异,对设备口袋血瘤和出血 (非常低确定性证据) 的影响非常不确定.
- 对于DOACs,IAC还在复合血栓栓塞事件和缺血性中风 (低确定性证据) 中几乎没有差异,对设备口袋血瘤和出血的影响非常不确定 (非常低确定性证据).
- 中等确定性证据表明,华法林和DOAC在深静脉血栓塞或肺栓塞方面几乎没有差异.
结论:
- 选择性CIED手术的中断抗凝药产生了与华法林和DOACs的不间断抗凝药类似的结果.
- 对大多数结果的证据确定性低至非常低.
- 进一步的RCT是至关重要的,以澄清中断抗凝剂对血栓栓塞事件和器件口袋血瘤的影响.
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