对心力衰竭的管理. 第四章 没有了 由于左心室缩功能障碍而导致心力衰竭的患者服用抗凝药
1Health Sciences Program, RAND, Santa Monica, Calif.
JAMA
|November 23, 1994
概括
动脉血栓栓塞发生在没有抗凝药的心力衰竭患者的0.9-5.5%中. 由于证据不足,不建议对心力衰竭患者进行抗凝治疗.
科学领域:
- 心脏病学 心脏病学
- 血管医学 血管医学
- 临床研究 临床研究
背景情况:
- 心力衰竭 (HF) 是一种复杂的疾病,与血栓栓塞事件的风险增加有关.
- 动脉血栓栓塞是HF患者的一个重大问题,特别是那些没有接受抗凝药治疗的人.
- 室腔功能障碍严重程度在影响血栓栓塞风险方面的作用需要进一步澄清.
研究的目的:
- 审查不接受抗凝药的心力衰竭 (HF) 患者的动脉血栓栓塞发生率.
- 为了检查更严重的腹腔功能障碍是否会增加血栓栓塞事件的发生率.
- 评估抗凝剂的有效性和风险,以对HF患者的鼻节律.
主要方法:
- 从1966年1月到1993年9月的英语语言研究的系统审查.
- 搜索的数据库包括MEDLINE和EMBASE,使用与心力衰竭和血栓塞栓相关的术语.
- 研究包括了不服用抗凝药的慢性心力衰竭患者;排除的是患有膜疾病,二次心力衰竭或夏加斯病的患者.
主要成果:
- 动脉血栓栓塞的发生率在每 100 个患者年中从 0.9 到 5.5 个事件不等.
- 最大的研究报告发生率为2.0%和2.4%.
- 关于心室功能与血栓塞栓事件之间的联系的研究结果是矛盾的.
结论:
- 没有对照性试验评估了HF患者的抗凝血疗效或风险.
- 在案例系列中报道的抗凝药疗效差异很大 (0%至100%).
- 由于缺乏足够的支持性研究,目前对于心力衰竭患者的鼻腔节律,不建议使用抗凝药.
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