左心室尾阻塞与透析中的抗凝剂与心室的透析
Gaurav Dhar1, Milind A Phadnis2, Suzanne L Hunt2
1Department of Internal Medicine, Rush University, Chicago, Illinois.
JAMA network open
|September 9, 2025
概括
与口服抗凝剂 (OAC) 相比,左心房尾闭塞 (LAAO) 在心房动 (AF) 患者的功能衰竭 (KF) 中显示出更好的生存率和降低的出血风险. 这表明LAAO可能是一个更安全的替代方案来降低这一群体中风风险.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 医疗器械 医疗器械
背景情况:
- 在透析中患有功能衰竭 (KF) 的患者有较高的心房动 (AF) 发生率.
- 在KF患者中,AF增加了中风,死亡和出血的风险.
- 在KF患者中,口服抗凝剂 (OAC) 会增加出血风险,从而限制其益处.
研究的目的:
- 为了比较OACs的安全性和有效性与左心房尾闭塞 (LAAO) 对于KF患者的AF风险降低.
主要方法:
- 使用美国脏数据系统注册 (2015-2018) 的回顾性队列研究.
- 在透析中对KF和新发性AF患者的倾向匹配分析.
- 在LAAO和OAC组之间比较了包括死亡,非致命出血和非致命中风在内的结果.
主要成果:
- 这项研究包括2344名患者 (293名LAAO,2051名OAC).
- 与OAC相比,LAAO与明显降低的死亡风险 (HR,0.47) 和复发性出血事件 (HR,0.74) 有关.
- 对LAAO进行非致命性中风风险降低的趋势被观察到,但在调整后没有统计学意义.
结论:
- 在患有功能衰竭 (KF) 和心房动 (AF) 的患者中,左心房塞 (LAAO) 显示出比口服抗凝剂 (OAC) 更好的生存率和更低的出血风险.
- 这些发现支持在这个高风险人群中考虑LAAO在共同决策中进行中风风险管理.
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