在外周内血管手术前,期间和之后,治疗氨酸诱导的血栓塞缩症的抗凝药
Silvia Cardi1,2, Alice Trinchero3, Jan-Dirk Studt3
1Department of Vascular Medicine, University Hospital Zurich, Switzerland.
VASA. Zeitschrift fur Gefasskrankheiten
|August 8, 2025
概括
在内血管手术期间管理肝素诱导的血小板缺血 (HIT) 是一个挑战. 本综述检查了非肝素抗凝剂比如比瓦利鲁丁和阿斯拉特罗班,强调个性化患者护理.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 血管外科 血管外科
背景情况:
- 乙胺诱导的急性血小板缺血 (HIT) 类型II需要立即停止乙胺和替代性抗凝治疗.
- 建议在HIT后终身避免使用肝素,因为存在复发风险,这会使内血管程序中的抗凝血复杂化.
- 在接受干预的HIT患者中,对于非肝素抗凝剂的证据有限.
研究的目的:
- 对HIT患者的内血管程序中抗凝管理的机构方法和当前指导方针进行审查.
- 在临床环境中检查非肝素抗凝剂作为肝素替代品的现有数据.
主要方法:
- 这篇叙事综述综合了当前的文献和机构实践.
- 关于非肝素抗凝剂的数据是从其他干预措施和小型回顾性队列的研究中推断出来的.
主要成果:
- 基于HIT患者皮肤冠状动脉干预的间接证据,可以考虑使用比瓦利鲁丁进行外周内血管干预.
- 阿尔加特罗班是主要的替代品,特别是对于功能障碍患者,因为比瓦利鲁丁面临着可用性和批准限制.
- 在特定的HIT患者 (远程/次急性HIT,负抗体) 中,手术内使用肝素是有争议的,但如果替代品不切实际,可以在紧急情况下考虑使用.
结论:
- 由于有限的可靠证据,对接受外周内血管干预的HIT患者的抗凝策略必须是个性化的.
- 患者教育和知情同意至关重要.
- 需要进一步的研究,以优化这种患者群体的抗凝剂管理.
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