没有抗凝血的心脏转变安全性在左心脏附属体封闭后的患者状态:系统性审查和元分析
Khalid Sawalha1, Mohammad Alakchar2, Mamas A Mamas3
1Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts Baystate, Springfield, MA, USA.
概括
在不使用抗凝剂的情况下,在左心房塞 (LAAO) 后的直流心脏转移 (DCCV) 是安全的. 这项研究发现中风和出血的风险较低,支持在选定的患者中使用.
科学领域:
- 心脏病学
- 电生理学
- 医疗器械
背景情况:
- 直流心转 (DCCV) 是对心房动 (AF) 的标准治疗方法.
- 在无法服用口服抗凝药 (OAC) 的患者中,左心房塞 (LAAO) 是预防中风的替代方案.
- 在LAAO之后,没有抗凝血的DCCV的安全性尚未得到充分证实.
研究的目的:
- 在接受LAAO的患者中,评估没有全身抗凝剂的DCCV的安全性和有效性.
- 为了比较DCCV抗凝药后和没有抗凝药后的患者之间的血栓塞并发症.
主要方法:
- 根据PRISMA指南进行系统审查和元分析.
- 从2010年1月到2025年4月搜索的主要数据库 (PubMed,ScienceDirect,Cochrane图书馆).
- 包括观察性研究,比较LAAO后的DCCV结果,有或没有抗凝剂,分析血栓栓塞和出血事件.
主要成果:
- 分析了使用1697种DCCV手术的5项研究.
- 血栓塞栓事件在没有OAC的情况下为3. 8%,而OAC时为1. 6% (OR为0. 48,p=0. 19).
- 临床显著的出血是相似的:没有OAC的4. 1%与OAC的4. 0% (OR1.22, p=0. 42).
结论:
- 没有抗凝血的DCCV在LAAO后的特定患者中似乎是安全的,前提是没有与器件相关的血栓或显著的泄漏.
- 血栓塞栓事件和出血的发生率较低.
- 由于观察数据有限,建议通过随机对照试验进行进一步验证.
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