抗凝剂在左心室尾闭塞后的作用
Maria Segarra-Queralt1, Marc Molla1, Manal Barrouhou1
1Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
JACC. Case reports
|October 25, 2025
概括
在左心房附属体封闭后,设备相关的血栓形成 (DRT) 可能会复发. 这一案例凸显了肺脊覆盖和适当的抗血栓治疗的重要性,这一点得到了新型多尺度模型的证实.
科学领域:
- 心血管医学 心血管医学
- 生物医学工程 生物医学工程
- 计算流体动力学的流体动力学.
背景情况:
- 左心房尾阻塞 (LAAO) 对于预防高出血风险的心房患者的血栓栓塞事件至关重要.
- 设备相关的血栓形成 (DRT) 是LAAO手术后的一个重大并发症.
- 目前用于DRT预防的策略需要进一步优化.
研究的目的:
- 为了研究LAAO后复发性DRT的机制.
- 评估装置放置和抗血栓治疗在DRT开发中的作用.
- 展示多尺度计算模型在理解DRT方面的实用性.
主要方法:
- 一个病例研究,一个患者在LAAO后使用Amplatzer Amulet设备进行了复发性DRT.
- 整合一个包含血动力学,血栓形成和抗血栓药物效应 (apixaban) 的多尺度模型.
- 模拟设备放置变化及其对纤维素沉积的影响.
主要成果:
- 在从阿皮克萨班过渡到阿司匹林后以及在停止服用阿皮克萨班后,观察到复发性DRT.
- 多尺度模型确定了肺脊以下的纤维素积累是DRT的关键因素,与临床发现相关.
- 在模型中优化设备的放置成功地阻止了纤维素的形成,这表明了DRT的机械部件.
结论:
- 肺脊的不完全覆盖和低于最佳的抗血栓管理有助于DRT复发.
- 肺脊覆盖和适当的直接口服抗凝剂 (DOAC) 治疗对于减少DRT至关重要.
- 开发的高保真多尺度模型提供了对抗血栓治疗和DRT的机制性见解,为其应用提供了概念验证.
相关概念视频
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
1.7K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.7K
01:29Venous Thrombosis III: Interprofessional Care
278
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
278
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
2.1K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.1K
01:24Cardiac Catheterization III: Left Heart Catheterization
572
Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
572
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
311
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
311