在皮肤冠状动脉和结构性干预中直接口服抗凝剂的管理
Johanna Jones1, Benjamin Waters2, Paul Wright2
1Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
Kardiologia polska
|February 13, 2026
概括
对于穿皮冠状动脉干预,持续使用直接口服抗凝剂 (DOAC) 是安全的. 然而,对于结构性干预,由于更高的出血风险,建议中止DOAC. 建议采用量身定制的方法.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 通过皮肤冠状动脉干预 (PCI) 期间直接口服抗凝剂 (DOAC) 的管理存在临床挑战.
- 目前的围绕程序管理策略是可变的,缺乏可靠的证据.
研究的目的:
- 审查DOAC的药理动力学,指南建议,以及中断与延续策略的证据.
- 在心脏干预期间为患者和程序特定的DOAC管理提供信息.
主要方法:
- 对DOACs的药理动力学特性进行文献综述.
- 评估当前关于DOAC管理的指导方针建议.
- 对冠状动脉和结构干预中DOAC策略的观察和前性研究的分析.
主要成果:
- 无间断的DOAC治疗在辐射接入的PCI中与低出血和血栓塞栓事件有关.
- 由于基线出血风险较高,最近的数据不支持在跨导管结构干预中继续使用DOAC.
- 建议采用患者和程序特定的方法,考虑接入地点,程序复杂性和功能.
结论:
- 在低风险的PCI患者中,可能不需要例行程序前的DOAC中断.
- DOAC管理应该是个性化的,远离统一的中断协议.
- 需要进一步的前性随机试验,以在特定患者群体中进行周围手术DOAC管理.
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