双重抗血小板治疗患者的血栓栓塞风险 带或不带肝素血栓预防治疗
Jonas Gmeiner1, Rainer Kaiser1, Julius Fischer1
1LMU Klinikum Medizinische Klinik und Poliklinik I, Munich, Germany.
Thrombosis and haemostasis
|May 19, 2025
概括
在接受双抗血小板治疗 (DAPT) 的住院患者中,低分子量肝素 (LMWH) 预防没有显示静脉血栓栓塞 (VTE) 率的差异,但增加了出血风险,由红细胞输血表明.
科学领域:
- 心脏病学 心脏病学
- 内部医学 内部医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 静脉血栓栓塞 (VTE) 是住院患者经常出现的并发症.
- 低分子量肝素 (LMWH) 是血栓预防的标准,但其在接受双抗血小板治疗 (DAPT) 的非手术患者的疗效和安全性尚未得到充分证实.
- 关于在同时接受DAPT的患者中LMWH的风险和益处的数据有限.
研究的目的:
- 评估LMWH血栓预防治疗在接受DAPT的住院患者中的有效性和安全性.
- 为了比较在DAPT的患者之间与LMWH预防和没有LMWH预防的VTE发生率和出血并发症.
主要方法:
- 从2015年5月到2025年4月,对8619名接受DAPT (阿司匹林加P2Y12抑制剂) 的住院心脏病患者进行了回顾性队列研究.
- 患者被分为两组:接受LMWH预防的患者 (n=2,378) 和没有接受LMWH预防的患者.
- 主要终点:住院期间VTE发生率. 二级终点:需要红细胞输血.
主要成果:
- 静脉瘤发病率非常低,在LMWH和非LMWH组之间没有显著差异 (0.04%对0%,p=0.28).
- 接受LMWH预防的患者表现出更高的红细胞输血率,这表明出血风险增加 (9.4%对5.1%,p=0.004).
- 亚组分析证实,DAPT患者的LMWH血栓预防与低VTE率相关,但出血并发症率较高.
结论:
- 在接受DAPT治疗的住院患者中,LMWH血栓预防似乎没有降低VTE发病率.
- 在这种患者群体中,LMWH的使用与出血并发症的风险增加有关,这可以通过更高的红细胞输血率来证明.
- 在DAPT患者中,常规使用LMWH用于血栓预防,由于可能增加出血,因此需要仔细考虑.
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