左心室辅助装置植入术后抗栓策略的单中心经验
Single-center experience on anti-thrombotic strategies for left ventricular assist device patients
俞亚红 1刘晓程 2刘志刚 2宋昱 3王伟 4贾克刚 5张云强 3王正清2
作者信息
- 1. 泰达国际心血管病医院药剂科,天津 300457
- 2. 泰达国际心血管病医院心外科,天津 300457
- 3. 泰达国际心血管病医院冠心病重症监护室,天津 300457
- 4. 泰达国际心血管病医院重症监护室,天津 300457
- 5. 泰达国际心血管病医院检验科,天津 300457
- 折叠
摘要
目的 初步探讨左心室辅助装置植入术后仅使用维生素K拮抗剂而不使用抗血小板治疗的安全性和有效性.方法 该研究为队列研究.连续入选2020年9月至2022年9月在泰达国际心血管病医院行HeartCon型左心室辅助装置植入术的患者.术后第1～2天予口服华法林钠,目标国际标准化比值(INR)2.0～2.5.随访至2022年9月,记录患者的生存情况、INR水平及出血和血栓形成发生情况.采用Kaplan-Meier法进行生存分析(对心脏移植进行删失).结果 共纳入22例患者,其中男性16例(72.7％),年龄(51.0±13.3)岁.HeartCon型左心室辅助装置支持时间为(458±166)d,支持期间患者的平均INR为2.28±0.26.1例患者在植入后307 d进行了心脏移植.随访期间发生心包填塞1例(4.5％),出血性卒中2例(9.1％),消化道出血5例(22.7％),牙龈出血4例(18.2％),鼻衄2例(9.1％);缺血性卒中1例(4.5％),泵血栓形成1例(4.5％),主动脉瓣血栓形成1例(4.5％).3、6个月及1、2年生存率分别为100％、95％、95％和95％.结论 植入HeartCon型左心室辅助装置患者术后单用华法林(目标INR 2.0～2.5)的抗栓策略可能是安全和有效的.
Abstract
Objective Preliminary explore the safety and efficacy of using only vitamin K antagonists without antiplatelet therapy after left ventricular assist devices(LVAD)implantation.Methods This is a cohort study.Patients who underwent HeartCon LVAD implantation in TEDA International Cardiovascular Hospital from September 2020 to September 2022 were included.Oral warfarin sodium was given on postoperative days 1 to 2,with the target international standardized ratio(INR)of 2.0 to 2.5.Follow-up until September 2022,survival,INR level and occurrence of bleeding and thrombosis were recorded.Survival analysis was performed by the Kaplan-Meier method(censored for heart transplantation).Results A total of 22 patients,including 16 male patients(72.7％),aged(51.0±13.3)years,were included.The duration of HeartCon LVAD support was(458±166)days and the INR during support was 2.28±0.26.One patient underwent the heart transplant at 307 d after implantation.One patient(4.5％)occured cardiac tamponade,two patients(9.1％)occured hemorrhagic stroke,five patients(22.7％)occured gastrointestinal bleeding,four patients(18.2％)occured gingival hemorrhage,two patients(9.1％)occured epistaxis,one patient(4.5％)occurred ischemic stroke,one patient(4.5％)occured pump thrombosis,and one patient(4.5％)occured aortic valve thrombosis.The survival rates were 100％,95％,95％,and 95％at 3 months,6 months,1 year,2 years after implantation respectively.Conclusion The single antithrombotic strategy using warfarin(target INR 2.0-2.5)without antiplatelet for patients with implantations of HeartCon type LVAD may be safe and effective.
关键词
心力衰竭/左心室辅助装置/抗栓策略/抗血小板治疗/出血/血栓形成Key words
Heart failure/Left ventricular assist device/Antithrombotic strategy/Anti-platelet therapy/Bleeding/Thromboembolism引用本文复制引用
基金项目
国家重点研发计划(2017YFC0111005)
出版年
2024
NETL
NSTL
万方数据