鉴定左心室血栓患者的抗凝固益处子组
Zechen Liu1,2,3, Boqun Shi1,2,4, Rui Zhang1,2,3
1Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, 100037 Beijing, China.
Reviews in cardiovascular medicine
|July 9, 2025
概括
抗凝固治疗的好处仅限于选择左心室血栓 (LVT) 患者. 较年轻的LVT患者,并发症较少,心肌病较多,抗凝药治疗结果改善.
科学领域:
- 心脏病学 心脏病学
- 临床研究 临床研究
- 血栓形成的管理
背景情况:
- 左心室血栓 (LVT) 与不良心血管和脑血管事件有关.
- 目前用于LVT的抗凝血策略显示出不同的有效性,特别是在亚洲人群中.
- 确定特定的LVT患者亚组,从抗凝药中获益至关重要.
研究的目的:
- 探索LVT患者临床表型的异质性.
- 为了确定哪些LVT患者亚组可以从抗凝治疗中受益.
- 调查抗凝剂与主要心血管和脑血管不良事件 (MACCEs) 和出血之间的关系.
主要方法:
- 隐性类分析 (LCA) 用于根据临床特征对1085名LVT患者进行分组.
- 卡普兰-梅尔曲线和考克斯分析评估了抗凝剂对MACCE和大出血的影响.
- 随访时间平均为36.5个月.
主要成果:
- 使用LCA确定了四个不同的患者群.
- 抗凝药仅在4组中显著降低了MACCE的风险 (HR:0.486,95%CI:0.243-0.971).
- 在其他群体或整体人群中没有观察到抗凝药的显著益处或危害;没有发现显著的出血风险.
结论:
- 抗凝治疗对所有LVT患者来说并不普遍有益.
- 年轻的LVT患者,并发症较少,心肌病较多,更有可能受益.
- 基于患者集群的个性化治疗策略是合理的.
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