在左心房附属体封闭后,对抗血栓治疗选择的安全性审查
Aanchal Sawhney1, Rahul Gupta2, Pranav Mahajan3
1Department of Internal Medicine, Crozer Chester Medical Center, Upland, PA, USA.
Expert opinion on drug safety
|August 12, 2025
概括
对于接受左心房尾闭塞 (LAAO) 的患者,直接口服抗凝剂 (DOACs) 显示为初始抗血栓单一治疗的前景,平衡出血和设备相关血栓的低风险. 双重抗血小板治疗 (DAPT) 与单一抗血小板治疗 (SAPT) 相比,进一步减少了血栓栓塞事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成的管理
背景情况:
- 左心房尾闭塞 (LAAO) 为非膜心房动 (NVAF) 患者提供了口服抗凝药的替代方案,患者不能耐受抗凝药.
- 目前LAAO后的抗血栓策略在很大程度上是基于共识的,患者通常接受口服抗凝剂,然后服用抗血小板剂.
- 患者对标准抗血栓治疗方案的耐受性各不相同,需要探索替代治疗选择.
研究的目的:
- 根据LAAO,审查各种抗血栓治疗选择的安全性和有效性概况.
- 为了比较不同抗血栓治疗方案中与器件相关的血栓塞 (DRT),出血和血栓栓塞事件的发生率.
- 总结来自随机对照试验和关于抗血栓组合和持续时间的元分析的当前证据.
主要方法:
- 对最近的随机对照试验和元分析进行了全面的审查.
- 分析安全概况,包括设备相关的血栓,出血事件和血栓栓塞结局.
- 直接口服抗凝剂 (DOAC),维生素K对抗剂 (VKA),单抗血小板治疗 (SAPT) 和双抗血小板治疗 (DAPT) 的比较.
主要成果:
- 最初的LAAO后的DOACs抗血栓单疗法与低血栓栓塞率,DRT和严重出血有关.
- 双重抗血小板治疗 (DAPT) 显示,与单一抗血小板治疗 (SAPT) 相比,血栓栓塞事件的发生率较低.
- 将DOAC与抗血小板治疗结合使用需要仔细考虑出血风险与血栓栓塞保护的风险.
结论:
- 在LAAO后,DOAC单疗似乎是一种安全有效的初始策略,提供了有利的风险平衡.
- 与LAAO之后的SAPT相比,DAPT对血栓栓塞事件提供了更好的保护.
- 个性化的抗血栓策略,考虑到患者特异性因素和团队与患者之间的讨论,对于LAAO后的最佳结果至关重要.
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