尽管使用抗凝血药物,但在心房中持续存在左心房尾血栓
Alexander Kushnir1, Scott Bernstein1, Chirag R Barbhaiya1
1Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA.
Journal of cardiovascular electrophysiology
|May 15, 2025
概括
在心房患者中,尽管服用足够的口服抗凝剂 (OAC),仍可能发生持续的左心房尾血栓. 在某些情况下,切换OAC药物或延长治疗时间可以解决血栓.
科学领域:
- 心脏病学 心脏病学
- 内部医学 内部医学
- 血栓形成研究研究
背景情况:
- 目前的心房指南表明,4周不间断的口服抗凝剂 (OAC) 足以排除手术前的左心房附属体血栓.
- 然而,即使有记录的OAC合规性,也可以在一些患者中观察到持久性血栓.
研究的目的:
- 评估左心房附属体 (LAA) 血栓出现的患者的特征和管理策略,尽管他们遵守OAC.
- 为了评估这个患者队列的结果和治疗疗效.
主要方法:
- 对在手术前通过食管回声心图 (TEE) 确定LAA血栓的患者进行了临床病史,管理和结局的审查.
- 该研究包括了在2021年至2024年期间接受AF相关手术的患者.
主要成果:
- 在3653例手术前TEE中,65例 (1.8%) 显示LAA血栓. 其中,39名患者 (60%) 记录了至少4周的OAC遵守情况.
- 阿皮克萨班是最常见的OAC (64%). 两名患者 (3%) 经历了栓塞事件,8名 (12%) 在随访期间死亡.
- 在切换OAC药物或继续治疗后,12/32名患者 (31%) 发生了血栓解脱. 左心房尾阻塞 (LAA-O) 在7名持久性血栓患者中取得了成功.
结论:
- 在接受LAA血栓手术的患者中,很大一部分 (60%) 坚持OAC超过4周.
- 在31%的病例中,切换OAC药物或延长治疗时间导致了血栓溶解,而LAA-O为持续的血栓提供了替代方案.
- 与在TEE上发生血栓的可能性较低相关的因素包括非膜AF,OAC遵守>4周,CHADS-VASc得分≤2,和正常的射出分数.
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