基于导管的干预在中低风险的肺栓塞中几乎没有益处
Anthony J Laico1, Junji Tsukagoshi2, Omar Sahibzada2
1John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Journal of vascular surgery
|August 13, 2025
概括
对于中低风险肺栓塞 (PE) 的导管疗法 (CBT) 显示,与单独抗凝药相比,死亡率没有好处,但会增加内出血风险. 系统性血栓溶解与高死亡率有关.
科学领域:
- 心脏病学和肺部医学.
- 干预心脏病学 干预心脏病学
- 血管医学 血管医学
背景情况:
- 基于导管的疗法 (CBT) 是为高风险的肺栓塞 (PE) 建立的.
- 在较低风险的PE患者中增加CBT的使用缺乏明确的疗效数据.
- 对中低风险PE中CBT的评估至关重要.
研究的目的:
- 评估导管治疗 (CBT) 与抗凝血 (AC) 和全身血栓溶解 (ST) 在中低风险肺栓塞 (PE) 的疗效和安全性.
- 为了在治疗组中比较死亡率,出血并发症和肺高血压率.
- 分析PE的CBT使用趋势.
主要方法:
- 使用TriNetX数据库 (2010年12月至2024年12月) 进行的多中心回顾性队列研究.
- 确定的中低风险PE患者 (常压,右心应变,没有升高的生物标志物).
- 将三个队列进行比较:仅抗凝血 (AC),全身血栓溶解 (ST) 和以导管为基础的治疗 (CBT) 使用倾向性得分匹配;结果在30天和3年间隔评估.
主要成果:
- 使用CBT增加了387%;45.5%接受了导管式血栓溶解,52.0%接受了机械血栓切除术.
- 认知性治疗没有显示出与AC相比的死亡率差异. 30天内内出血 (ICH) 在CBT中较高 (OR 2.12),但3年内胃肠道出血较低 (OR 1.45).
- 与AC和CBT相比,系统性血栓溶解 (ST) 在3年内显示出明显更高的死亡率. 所有组的肺高血压率都很低.
结论:
- 在中低风险PE中,CBT比AC提供最小的死亡率或胃肠道出血的好处,随着外科手术期间ICH风险的增加.
- 与AC相比,系统性血栓溶解 (ST) 与不可接受的高死亡率和出血并发症有关.
- 需要进一步的研究,以优化中低风险PE患者的患者选择和治疗方式.
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