心肌梗死后左心室附壁血栓患者体循环栓塞发生情况及不同种类抗凝药物治疗效果分析  

Incidence of Systemic Embolism in Patients With Left Ventricular Thrombus After Myocardial Infarction Treated With New Oral Anticoagulants or Vitamin K Antagonists

作　　者：晁鹏 李杰[1] 陈晓洋[1] 王勇[1] 任澎[1] CHAO Peng;LI jie;CHEN Xiao-yang;WANG Yong;REN Peng(Department of Cardiology,People's Hospital of Xinjiang Autonomous Region,Urumuqi (830001),Xinjiang,China)

机构地区：[1]新疆维吾尔自治区人民医院心内科,乌鲁木齐市830001

出　　处：《中国循环杂志》2018年第12期1184-1188,共5页Chinese Circulation Journal

摘　　要：目的:探讨心肌梗死后左心室附壁血栓(LVT)患者体循环栓塞发生情况及新型口服抗凝药物(NOAC)及传统维生素K拮抗剂治疗的优劣以及口服抗凝药物最佳时间的选择。方法:选取2012～2017年就诊于新疆维吾尔自治区人民医院所有确诊心肌梗死后LVT形成的145例患者作为LVT组,随机抽取同时间段明确诊断为急性心肌梗死但未形成LVT的238例患者作为非LVT组,对两组患者进行随访,主要终点事件为新发体循环栓塞事件,次要终点为出血事件的发生。结果:最终LVT组有136例,非LVT组有216例患者参与了研究,中位随访时间为33.8个月。新发体循环栓塞在LVT组共有23例(16.9%),非LVT组共有11例(5.1%),LVT组发生风险更高(HR=5.8,95%CI:1.51～8.98,P<0.001);LVT组口服华法林患者70例,口服利伐沙班56例,口服华法林患者中12例(17.1%)出现新发体循环栓塞,口服利伐沙班患者中有2例(3.6%)出现新发体循环栓塞,两者在栓塞事件方面差异有统计学意义(17.1%vs 3.6%,HR=2.138, 95%CI:1.086～3.974,P=0.029),口服华法林患者中共11例(15.7%)出血,口服利法沙班患者中5例(8.9%)出血,两组差异无统计学意义(HR=1.14, 95%CI:0.832～1.245,P=0.32)。口服抗凝药物<5个月,5～11个月,12～14个月、15～18个月发生栓塞事件分别为7例,4例,2例,1例(P=0.021)。结论:LVT是体循环栓塞的独立危险因素,NOACs与维生素K受体拮抗剂相比可在不增加出血风险的基础上减少栓塞事件的发生,且抗凝时间越长,发生栓塞事件的概率越小。Objectives: To investigate the incidence of systemic embolism in patients with left ventricular thrombosis after myocardial infarction treated with new oral anticoagulant drugs(NOACs) or traditional vitamin K antagonists, and the best time point of initiation the anticoagulants therapy in these patients. Methods: 145 patients diagnosed with LVT after myocardial infarction from 2012 to 2017 in the People’s Hospital of Xinjiang Uygur Autonomous Region were included, 238 patients with acute myocardial infarction without LVT(non-LVT) served as the control group, the primary end point was the new embolism and the secondary end point was the occurrence of bleeding. Results: Finally, data from 136 LVT patients and 216 non-LVT patients were analyzed, the median follow-up time was 33.8 months, a total of 23 patients(16.9%) in the LVT group and 11 patients in the non-LVT group(5.1%) developed new systemic embolism(HR=5.8,95%CI: 1.51-8.98, P<0.001). Among LVT patients, 70 patients received warfarin therapy and 56 patients were treated with Rivaroxaban. Systemic embolism was observed in 12 patients(17.1%) in the warfarin group and in 2 patients(3.6%) in rivaroxaban group(HR= 2.138, 95%CI:1.086-3.974,P=0.029). Incidence of bleeding was similar between warfarin group(n=11, 15.7%), and rivaroxaban group(n=5, 8.9%, HR=1.14, 95%CI: 0.832-1.245, P=0.32). Patients who accepeted anticoagulation were divided into four groups,less than 5 months,5 to 11 months,12 to 14 months, and 15 to 18 months group,the occurance of embolism was 7,4,2,and 1 patients(P=0.021).Conclusions: LVT is an independent risk factor for systemic embolism in patients post myocardial infarction. Compared with vitamin K antagonist, rivaroxaban can reduce the incidence of embolism events without increasing the risk of bleeding. The longer the anticoagulation time is, the smaller the probability of embolism events.

关 键 词：左心室附壁血栓 抗凝治疗 体循环栓塞 

分 类 号：R541[医药卫生—心血管疾病]