患有遗传性出血障碍的患者的抗血栓治疗:实际考虑
Jerzy Windyga1, Riitta Lassila2
1Department of Hemostasis Disorders and Internal Medicine, Laboratory of Hemostasis and Metabolic Diseases, Institute of Hematology and Transfusion Medicine, Warszawa, Poland. jwindyga@ihit.waw.pl
Polish archives of internal medicine
|April 8, 2025
概括
血友病 (PWH) 患者在历史上有较低的血栓栓塞 (TE) 风险. 现在改善的管理意味着PWH可以发展TE,需要仔细考虑抗凝剂治疗和替代治疗来最大限度地降低出血风险.
科学领域:
- 血液学 血液学 血液学
- 心脏病学 心脏病学
- 血管医学 血管医学
背景情况:
- 长期以来,人们一直认为血友病等遗传性出血障碍可以预防血栓栓塞 (TE).
- 这种看法源于历史上的低预期寿命和血友病患者 (PWH) 缺乏观察到的TE.
- 血友病管理的进步增加了预期寿命,导致在PWH中识别TE事件.
研究的目的:
- 审查并提供有关在患有遗传性出血障碍的个体中管理动脉和静脉TE的指导.
- 在血友病管理的背景下讨论抗凝药疗法的安全性和有效性.
主要方法:
- 对遗传性出血障碍中血栓栓塞的当前文献的综述.
- 基于凝血因子水平 (第八或第九因子>20 IU/dL) 的抗凝血剂治疗安全性的分析.
- 评估替代性抗血栓策略,以尽量减少暴露.
主要成果:
- 在没有预防的严重/中度血友病中,应谨慎使用抗凝剂治疗.
- 当因子VIII或IX水平始终≥20IU/dL时,治疗性抗凝药更安全.
- 在PWH中,直接口服抗凝剂是预防中风和静脉TE治疗的首选.
结论:
- 血友病患者有发生血栓栓塞事件的风险.
- 管理需要仔细平衡抗凝血风险和益处.
- 其他策略,如心脏转移,切除,LAA封闭和药物排泄支架,可以最大限度地减少抗血栓暴露.
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