在接受选择性手术的机械大动脉患者中进行外科手术期间的肝素桥梁:珀研究
Alejandro Godoy1, Tegvir S Grewal2, Vinai Bhagirath3
1Population Health Research Institute, Hamilton, Ontario, Canada; Department of Thrombosis, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Vascular Medicine and Thrombosis Service, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
JACC. Advances
|January 24, 2026
概括
对于有机动动脉的患者来说,外科手术期间低分子量肝素 (LMWH) 桥接并没有减少罕见的血栓栓塞事件,但显著增加了出血风险. 由于安全问题,可选程序可能不需要LMWH桥接.
科学领域:
- 心血管医学 心血管医学
- 血栓形成和血液静止.
- 膜心脏疾病 膜心脏疾病
背景情况:
- 在选择性手术期间,低分子量肝素 (LMWH) 桥梁治疗胆叶片机械大动脉患者的外科手术期间的安全性和有效性尚不清楚.
- 虽然LMWH的目标是在华法林中断期间预防血栓栓塞,但其增加出血风险的潜力需要研究,而没有明显的益处.
研究的目的:
- 在接受选择性手术的机械大动脉患者中比较血栓栓塞和出血率,比较不同的外科手术期间的LMWH桥梁策略与没有桥梁策略.
- 评估LMWH桥梁策略与不良事件之间的关联,包括动脉血栓栓塞和各种出血结果.
主要方法:
- 一个多中心的回顾性队列研究,涉及553名需要停止服用华法林的患者.
- 患者被分为几组:手术前和手术后的LMWH,手术前的LMWH,手术后的LMWH和没有桥梁.
- 结果,包括动脉血栓栓塞,重大出血和临床相关的非重大出血,使用多变量逻辑回归和倾向匹配比较进行了分析.
主要成果:
- 血栓栓塞栓事件很少发生 (<0.5%),并且在研究的桥梁策略中没有显著差异.
- 与没有桥梁相比,完全外科手术期间的LMWH桥梁 (手术前和术后) 与严重出血 (3.0%与0%) 和任何临床相关出血 (9.5%与2.0%) 的比率大大提高.
- 倾向匹配分析证实,完全桥接增加了临床相关出血的风险 (10.6%对2.4%).
结论:
- 在接受选择性手术的胆叶片机械大动脉患者中,在30天内发生的血栓塞栓事件很少见.
- 完全外科手术期间的LMWH桥梁与增加出血风险有关,但在预防血栓塞栓症方面没有证明有效的益处.
- 需要进一步的前性临床试验来验证这些发现,并完善桥梁策略.
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