在左心房附属体封闭后进行抗血栓治疗
Carmelo Raffo1, Antonio Greco1, Davide Capodanno1
1Cardiovascular Department, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy.
Expert review of cardiovascular therapy
|March 28, 2025
概括
在左心房尾阻塞 (LAAO) 后的抗血栓治疗对于预防与设备相关的血栓形成至关重要. 直接口服抗凝剂 (DOAC) 似乎是最有效的,在心房患者中平衡安全性和疗效.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成的管理
背景情况:
- 左心房尾阻塞 (LAAO) 用于降低心房动 (AF) 患者中风风险.
- 在LAAO手术中存在风险,包括出血,设备栓塞,泄漏和与设备相关的血栓形成.
- 抗血栓治疗是LAAO后必不可少的,以防止由于血液与器件接触而导致的血栓形成.
研究的目的:
- 审查LAAO之后的抗血栓治疗的理由和影响.
- 提供有关LAAO后各种抗血栓治疗方案的当前证据的概述.
- 为LAAO患者定义最佳的抗血栓策略.
主要方法:
- 在PubMed,科学网络和Cochrane数据库中进行全面的文献搜索,截至2024年11月.
- 对抗血栓类药物的分析,包括VKA,DOAC,抗血小板剂和组合药物.
- 评估从高强度到简化方案的发展策略.
主要成果:
- 目前的策略旨在简化抗血栓治疗方法,以促进器械愈合,同时最大限度地降低出血风险.
- 直接口服抗凝剂 (DOACs) 显示出血栓栓塞事件和严重出血的最低率.
- 双抗血小板疗法 (DAPT) 是对口服抗凝剂 (OAC) 不耐受的患者的选择.
结论:
- 在LAAO后的最佳抗血栓治疗方案仍在争论中,需要进一步的随机试验.
- 由于其有利的风险/收益概况,建议DOAC作为首选选项.
- 对于高出血风险的患者,单次抗血小板治疗或不使用抗血小板治疗是可行的替代方案.
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