脊髓缩中的左心室血栓:治疗国际规范化比率失败的案例
Muhammad Salman Sabri1, Carly Weber2, Yanis Belkadi3
1Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA.
JACC. Case reports
|September 5, 2025
概括
即使使用抗凝药,风湿性心肌狭窄和心房的患者也面临左心房血的高风险. 在心脏转移之前, 透食心声图对于检测高危人群中的血栓至关重要.
科学领域:
- 心脏病学
- 心脏电生理学
- 医学成像
背景情况:
- 风湿性心肌狭窄症 (MS) 与左心房附属体 (LAA) 血栓的风险增加有关,特别是在心房或动的患者中.
- 在这种患者群体中,治疗抗凝剂可能并不总是能防止LAA血栓形成.
- 左心房 (LA) 血栓造成血栓事件的重大风险.
研究的目的:
- 突出在风湿性多发性硬化和心房的患者中增加LAA血栓的风险.
- 在这种特定的患者群体中,强调过食管回声图 (TEE) 在心脏转移前的重要性.
- 在风湿性MS的背景下讨论LAA血栓的治疗策略.
主要方法:
- 一名72岁的女性患有中度多发性硬化和心房动,
- 诊断评估包括经食道心声图 (TEE) 来评估LAA血栓.
- 治疗包括调整抗凝目标和推迟心脏转变.
主要成果:
- 在患有类风湿性多发性硬化和心房的患者中,在TEE检测中发现了大量的LAA血栓,尽管国际正常化比率 (INR) 超过2. 5.
- 由于LAA血栓的存在,心脏转移被推迟.
- 治疗INR目标增加到2. 5- 3. 5.
结论:
- 患有风湿性多发性硬化和同时出现心房的患者有LAA和LA血栓的高风险,因此在心脏转移之前需要TEE.
- 在风湿性多发性硬化症患者中,心脏转移的决定应以TEE发现为指导,以减轻栓塞风险.
- 需要进一步的研究来确定LAA血栓在风湿性MS的最佳治疗方法,包括手术.
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