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在急性甲型大动脉剖析中使用直接口服抗凝剂的管理
Robert Semco1, Thais Faggion Vinholo2, Jake Awtry2
1Harvard Medical School, Boston, Massachusetts.
Aorta (Stamford, Conn.)
|May 9, 2025
概括
在急性A型大动脉解剖 (ATAAD) 中,直接口服抗凝剂 (DOAC) 的管理具有挑战性. 因子补充提供了一个成功的策略,而安德xanet-alfa在特定的手术环境中带有安全问题.
科学领域:
- 心血管外科心血管外科
- 药理学 药理学是指药理学的学科.
- 血液学 血液学 血液学
背景情况:
- 直接口服抗凝剂 (DOAC) 广泛使用,但对于急性A型大动脉剖析 (ATAAD) 等外科紧急情况构成挑战.
- 在DOAC治疗的ATAAD患者中,有效的治疗策略对于优化手术结果至关重要.
研究的目的:
- 描述在DOAC上的ATAAD患者的手术管理和临床过程.
- 在ATAAD中审查有关DOAC逆转剂的文献.
主要方法:
- 病例系列的患者与ATAAD在DOACs.
- 在ATAAD中使用DOAC逆转剂的文献综述.
主要成果:
- 一名接受安德克萨内特-阿尔法治疗的患者在心肺旁路术期间经历了肝素不敏感.
- 四名患者通过延迟手术和因子补充成功治疗.
- 文献审查表明,在术后使用时,安德克萨内特-阿尔法对肝素不敏感或血栓的安全性存在担忧.
结论:
- 在ATAAD中DOAC的术前管理可以通过因子补充成功实现.
- 安德克萨内特-阿尔法的使用带有风险,特别是在心肺绕道/体外膜氧化之前或期间.
- 指导方针建议在肝素化前不久避免使用安德克萨内特-阿尔法,但在肝素逆转后危及生命的出血时可以考虑使用它.
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