心脏转变后的抗凝药在心房动与左心房尾闭塞的心房动中:是否必要?
Sittinun Thangjui1, Angkawipa Trongtorsak2, Jakrin Kewcharoen3
1Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA.
International journal of cardiology
|June 21, 2025
概括
心脏转变后的口服抗凝剂 (OAC) 在心房 (AF) 患者中,左心房尾闭塞 (LAAO) 没有显示出中风或出血风险的显著差异. 需要进一步的前性研究来指导临床实践.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 电力生理学 电力生理学
背景情况:
- 在患有心房动 (AF) 的患者中,心脏转变后口服抗凝剂 (OAC) 的最佳使用,这些患者经历了左心房尾封闭 (LAAO) 并未明确.
- 关于这一特定患者群体中风,全身血栓栓塞 (SSTE) 和出血风险的数据有限.
研究的目的:
- 调查AF患者之前患有LAAO的AF患者在电心转变 (eCVN) 后的临床结果,特别是中风和出血事件.
- 在AF和LAAO患者中,比较心转后OAC与没有OAC的安全性和有效性.
主要方法:
- 使用TriNetX研究网络进行了一项回顾性队列研究.
- 患者有之前的外科手术或皮肤间的LAAO,没有中风史,并且在确定eCVN之前至少一个月没有OAC.
- 倾向性得分匹配 (PSM) 用于比较接受OAC心转后治疗的患者和不接受OAC治疗的患者之间的结果.
主要成果:
- 该研究包括1507名符合条件的患者,583人 (38.7%) 接受心转后OAC.
- 在PSM之后,在每个组中分析了551名患者 (OAC与非OAC).
- 在SSTE (OR 0.59,95%CI:0.31-1.13) 或缺血性中风/暂时缺血性发作 (OR 0.69,95%CI:0.35-1.92) 之间没有观察到统计学上显著的差异. 出血率也是相似的 (6.0%对5.3%;OR1.15,95%CI:0.67-1.92).
结论:
- 在患有AF和先前经过心脏转变的LAAO患者中,手术后使用OAC与SSTE或出血风险的显著差异无关.
- 这些发现表明,目前的OAC策略可能不会改变这一群体的结果.
- 需要进行前性研究,以提供明确的证据,并为这些患者的抗凝血管理提供临床指南.
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