患有左心室血栓的患者的复发性缺血性中风尽管有阿皮克萨班:成功过渡到华法林
Mohd Imran Patel1, Sindhuja Kannan1, Riya M Jacob1
1Internal Medicine, Prince Charles Hospital, Merthyr Tydfyl, GBR.
Cureus
|October 20, 2025
概括
即使使用直接口服抗凝剂,左心室血栓也可能导致中风. 在患有复发性中风的患者中,转换为华法林与肝素桥接有效地预防了进一步的栓塞事件.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 左心室 (LV) 血栓是心血管血栓性中风的重要原因,特别是在减少LV射出分数 (LVEF) 的患者中.
- 抗凝药是标准的治疗方法,但药物选择仍在讨论中.
研究的目的:
- 在患有LV血栓的患者中出现复发性缺血性中风的病例,尽管直接服用口服抗凝剂 (DOAC) 治疗.
- 在这种情况下,突出转换为低分子量肝素 (LMWH) 过渡到华法林的潜在好处.
主要方法:
- 一个68岁的男子患有LV血栓和复发性缺血性中风的病例报告.
- 大脑MRI证实了急性心脏病发作.
- 患者从阿皮克萨班转换为华法林,并与LMWH桥接.
主要成果:
- 患者在接受apixaban治疗时经历了复发性缺血性中风.
- 与LMWH桥接过渡到华法林导致稳定的国际正常化比率 (INR).
- 切换后没有观察到进一步的临床明显的栓塞事件.
结论:
- 即使使用DOACs,LV血栓也存在栓塞风险.
- 在启动华法林治疗时,LMWH桥梁至关重要.
- 多学科管理对于优化复杂心血管病例的结果至关重要.
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