摘要
目的探讨左心耳封堵术(LAAC)联合延迟抗凝治疗在心房颤动合并抗凝期间发生心源性卒中患者中的安全性和有效性。方法采用前瞻性研究的方法,选取首都医科大学宣武医院2020年9月至2022年6月行LAAC联合延迟抗凝治疗的心房颤动合并抗凝期间心源性卒中患者35例。评估终点为LAAC联合延迟抗凝治疗的安全性和有效性,主要有效性终点为术后的死亡、心肌梗死、出血性脑卒中和体循环栓塞的复合终点,安全性终点为国际血栓形成和止血协会定义的大出血及临床相关的非大出血。结果35例患者中,男21例,女14例;年龄(68.5±9.3)岁;CHA2DS2-VASc评分5(4,6)分;距离末次卒中时间95(42,98)d;发生卒中时美国国立卫生研究院卒中量表评分3(1,6)分。所有患者均成功完成LAAC,围手术期未发生器械表面血栓、死亡、新发卒中或出血事件。32例在LAAC术后45 d继续口服抗凝治疗。随访(12.6±4.3)个月,1例发生缺血性脑卒中,2例发生黏膜出血,未出现全因死亡、心血管死亡、体循环栓塞和出血性脑卒中等不良事件。结论LAAC联合延迟抗凝治疗对于心房颤动患者安全有效,对于心房颤动合并抗凝期间发生心源性卒中患者,可考虑在LAAC基础上联合延迟抗凝治疗进一步预防缺血性脑卒中事件。
Objective To assess the safety and efficiency of left atrial appendage closure(LAAC)combined delayed anticoagulant therapy in atrial fibrillation(AF)patients combined with cardiogenic stroke during anticoagulant therapy.Methods Using prospective research methods,35 AF patients combined with cardiogenic stroke during anticoagulant therapy from September 2020 to June 2022 in Xuanwu Hospital,Capital Medical University were selected.All patients were treated with LAAC and delayed anticoagulant therapy.The endpoints were the safety and efficacy of LAAC combined with delayed anticoagulant therapy.The primary endpoint of efficacy was the composite endpoint of postoperative death,myocardial infarction,hemorrhagic stroke and systemic embolism.The safety endpoint was major bleeding as defined by the International Society for Thrombosis and Hemostasis and clinically relevant non-major bleeding.Results Among 35 patients,21 were males and 14 were females;the age was(68.5±9.3)years old;the CHA2DS2-VASc score was 5(4,6)scores;the time to the last stroke was 95(42,98)d;the National Institutes of Health stroke scale score at the time of stroke was 3(1,6)scores.All patients successfully completed LAAC without perioperative instrument-surface thrombosis,death,new stroke or bleeding events.Thirty-two patients continued oral anticoagulant therapy 45 d after LAAC.The patients were followed up for(12.6±4.3)months,1 patient experienced recurrent ischemic stroke,2 patients endured mucosal bleeding,there were no adverse events such as all-cause death,cardiovascular death,systemic embolism and hemorrhagic stroke.Conclusions The LAAC combined delayed anticoagulant therapy is efficient and safe in patients with AF.For AF patients combined with cardiogenic stroke during anticoagulant therapy,LAAC combined with delayed anticoagulation therapy may be considered to further prevent ischemic stroke events.
作者
武德崴
王宇彬
李博宇
夏经钢
许骥
尹春琳
Wu Dewei;Wang Yubin;Li Boyu;Xia Jinggang;Xu Ji;Yin Chunlin(Department of Cardiology,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100053,China)
出处
《中国医师进修杂志》
2023年第1期14-18,共5页
Chinese Journal of Postgraduates of Medicine
关键词
心房颤动
脑缺血
左心耳封堵术
抗凝治疗
Atrial fibrillation
Brain ischemia
Left atrial appendage closure
Anticoagulation therapy
