Baidu
map

Stroke:房颤患者冠状动脉支架置入术后卒中预防方案

2019-07-15 xing.T MedSci原创

由此可见,直接口服抗凝血方案与较少的大出血和主要心血管不良事件相关,但维生素K拮抗剂与死亡和卒中发生率降低相关。这些结果表明,经皮冠状动脉介入治疗后房颤患者的抗血栓治疗方案需要个体化。

冠状动脉支架置入术后房颤患者需要平衡血栓栓塞和出血事件,特别是急性卒中的最佳抗血栓治疗策略仍然存在争议。近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员进行了网络荟萃分析,以确定与冠状动脉支架术后房颤患者出血和血栓栓塞事件发生率最低相关的抗血栓形成治疗方案。

研究人员检索了PubMed、Scopus和Cochrane Central,确定了冠状动脉支架置入术后房颤患者的随机对照试验和观察性研究。感兴趣的结局是卒中、心肌梗塞、主要不良心脏事件、死亡和大出血。研究人员进行网络荟萃分析比较了文献中可用的抗血栓形成方案。

该分析纳入了三项随机和15项观察性研究,共有23478名参与者。中位随访时间为2年。网络荟萃分析表明,维生素K拮抗剂加单一抗血小板治疗或直接口服抗凝剂加单一抗血小板治疗是预防卒中的最有效方案。与维生素K拮抗剂方案相比,直接口服抗凝血方案与较低的大出血率相关。采用双重抗血小板治疗与较低的心肌梗死发生率相关。维生素K拮抗剂加双重抗血小板治疗与较低的死亡率,并且低剂量直接口服抗凝剂与主要心血管不良事件减少相关。

由此可见,直接口服抗凝血方案与较少的大出血和主要心血管不良事件相关,但维生素K拮抗剂与死亡和卒中发生率降低相关。这些结果表明,经皮冠状动脉介入治疗后房颤患者的抗血栓治疗方案需要个体化。 

原始出处:

Leonardo Knijnik.et al.Prevention of Stroke in Atrial Fibrillation After Coronary Stenting Systematic Review and Network Meta-Analysis.stroke.2019.https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.026078

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1766701, encodeId=96061e6670175, content=<a href='/topic/show?id=fc89e965910' target=_blank style='color:#2F92EE;'>#置入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79659, encryptionId=fc89e965910, topicName=置入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd637855499, createdName=小小小向日葵, createdTime=Sun Aug 04 20:30:00 CST 2019, time=2019-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1693866, encodeId=f77916938664b, content=<a href='/topic/show?id=30ab30866f0' target=_blank style='color:#2F92EE;'>#冠状动脉支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30866, encryptionId=30ab30866f0, topicName=冠状动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad0e29466742, createdName=xiaoyeshuang, createdTime=Sun Mar 01 03:30:00 CST 2020, time=2020-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447395, encodeId=bb56144e39521, content=<a href='/topic/show?id=35cc36081e2' target=_blank style='color:#2F92EE;'>#卒中预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36081, encryptionId=35cc36081e2, topicName=卒中预防)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd925339785, createdName=陈吴1236, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614514, encodeId=735b1614514d2, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026406, encodeId=13e110264066e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jul 15 22:30:00 CST 2019, time=2019-07-15, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1766701, encodeId=96061e6670175, content=<a href='/topic/show?id=fc89e965910' target=_blank style='color:#2F92EE;'>#置入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79659, encryptionId=fc89e965910, topicName=置入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd637855499, createdName=小小小向日葵, createdTime=Sun Aug 04 20:30:00 CST 2019, time=2019-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1693866, encodeId=f77916938664b, content=<a href='/topic/show?id=30ab30866f0' target=_blank style='color:#2F92EE;'>#冠状动脉支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30866, encryptionId=30ab30866f0, topicName=冠状动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad0e29466742, createdName=xiaoyeshuang, createdTime=Sun Mar 01 03:30:00 CST 2020, time=2020-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447395, encodeId=bb56144e39521, content=<a href='/topic/show?id=35cc36081e2' target=_blank style='color:#2F92EE;'>#卒中预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36081, encryptionId=35cc36081e2, topicName=卒中预防)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd925339785, createdName=陈吴1236, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614514, encodeId=735b1614514d2, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026406, encodeId=13e110264066e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jul 15 22:30:00 CST 2019, time=2019-07-15, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1766701, encodeId=96061e6670175, content=<a href='/topic/show?id=fc89e965910' target=_blank style='color:#2F92EE;'>#置入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79659, encryptionId=fc89e965910, topicName=置入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd637855499, createdName=小小小向日葵, createdTime=Sun Aug 04 20:30:00 CST 2019, time=2019-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1693866, encodeId=f77916938664b, content=<a href='/topic/show?id=30ab30866f0' target=_blank style='color:#2F92EE;'>#冠状动脉支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30866, encryptionId=30ab30866f0, topicName=冠状动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad0e29466742, createdName=xiaoyeshuang, createdTime=Sun Mar 01 03:30:00 CST 2020, time=2020-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447395, encodeId=bb56144e39521, content=<a href='/topic/show?id=35cc36081e2' target=_blank style='color:#2F92EE;'>#卒中预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36081, encryptionId=35cc36081e2, topicName=卒中预防)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd925339785, createdName=陈吴1236, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614514, encodeId=735b1614514d2, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026406, encodeId=13e110264066e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jul 15 22:30:00 CST 2019, time=2019-07-15, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1766701, encodeId=96061e6670175, content=<a href='/topic/show?id=fc89e965910' target=_blank style='color:#2F92EE;'>#置入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79659, encryptionId=fc89e965910, topicName=置入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd637855499, createdName=小小小向日葵, createdTime=Sun Aug 04 20:30:00 CST 2019, time=2019-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1693866, encodeId=f77916938664b, content=<a href='/topic/show?id=30ab30866f0' target=_blank style='color:#2F92EE;'>#冠状动脉支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30866, encryptionId=30ab30866f0, topicName=冠状动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad0e29466742, createdName=xiaoyeshuang, createdTime=Sun Mar 01 03:30:00 CST 2020, time=2020-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447395, encodeId=bb56144e39521, content=<a href='/topic/show?id=35cc36081e2' target=_blank style='color:#2F92EE;'>#卒中预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36081, encryptionId=35cc36081e2, topicName=卒中预防)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd925339785, createdName=陈吴1236, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614514, encodeId=735b1614514d2, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026406, encodeId=13e110264066e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jul 15 22:30:00 CST 2019, time=2019-07-15, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1766701, encodeId=96061e6670175, content=<a href='/topic/show?id=fc89e965910' target=_blank style='color:#2F92EE;'>#置入术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79659, encryptionId=fc89e965910, topicName=置入术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd637855499, createdName=小小小向日葵, createdTime=Sun Aug 04 20:30:00 CST 2019, time=2019-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1693866, encodeId=f77916938664b, content=<a href='/topic/show?id=30ab30866f0' target=_blank style='color:#2F92EE;'>#冠状动脉支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30866, encryptionId=30ab30866f0, topicName=冠状动脉支架)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad0e29466742, createdName=xiaoyeshuang, createdTime=Sun Mar 01 03:30:00 CST 2020, time=2020-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447395, encodeId=bb56144e39521, content=<a href='/topic/show?id=35cc36081e2' target=_blank style='color:#2F92EE;'>#卒中预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36081, encryptionId=35cc36081e2, topicName=卒中预防)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd925339785, createdName=陈吴1236, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614514, encodeId=735b1614514d2, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jul 17 10:30:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026406, encodeId=13e110264066e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jul 15 22:30:00 CST 2019, time=2019-07-15, status=1, ipAttribution=)]
    2019-07-15 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

相关资讯

JAHA:重复测量血清尿酸与房颤风险

由此可见,高血清尿酸盐水平和血清尿酸盐随时间的增加与AF的风险增加相关。血清尿酸盐和高敏感性C-反应蛋白处于高水平的患者具有显著更高的AF风险。

JAMA Cardiol:全新Meta分析称,当房颤遇到冠脉介入,氯吡格雷联合达比加群/利伐沙班更佳

近期发表在JAMA心脏病学子刊上的一项Meta分析表明,对于接受冠脉介入治疗或合并急性冠脉综合征(ACS)的房颤患者,一种新型口服抗凝药物(达比加群、利伐沙班等)联合一种P2Y12抑制剂(如氯吡格雷、替格瑞洛)可能是最好的抗栓治疗策略,而华法林+双联抗血小板治疗(阿司匹林+氯吡格雷)的抗栓策略最差。

CSA&TISC2019丨方堃教授畅谈房颤抗凝治疗的新突破与进展

编者按:临床实践中,心房颤动(房颤)患者的抗凝治疗应作何选择?对于PCI治疗、存在左心室血栓或不明原因栓塞性卒中、发生出血等特殊情况的患者,其抗凝治疗应何去何从?这一直是房颤抗凝治疗领域的难点和焦点问题。6月28日,在CSA&TISC 2019脑血管危险因素预防与控制专场,复旦大学附属华山医院方堃教授结合最新临床研究及指南推荐对上述现实问题作了全面解析。

JACC:直接口服抗凝剂对房颤伴肝脏疾病患者的临床研究

进展性肝脏疾病会增加出血风险,并且影响药物的清除和代谢。活动性肝脏疾病患者均在直接口服抗凝剂(DOACs)临床试验中被排除,因此,DOACs对肝脏疾病患者的有效性和安全性尚不清楚。本研究的目的旨在比较和评估DOACs和华法林对房颤伴肝脏疾病患者的影响。本研究纳入分析了韩国医保数据库中的房颤伴肝脏疾病的患者(12778名接受华法林治疗,24575名接受DOACs治疗),分析结果显示,与华法林相比,D

Eur Heart J:无卒中房颤患者的痴呆风险

由此可见,AF与痴呆风险增加有关,与老年人群的卒中无关。口服抗凝剂的使用与痴呆的发生率降低有关。

Eur Heart J:房颤可增52%痴呆风险,抗凝可预防

既往多项国内外研究表明,房颤与痴呆风险增加有关。我国兰州大学第二医院学者发现,高达40%的房颤患者存在血管性痴呆。

Baidu
map
Baidu
map
Baidu
map