左心室血栓诊治研究进展  

Research progress of the diagnosis and therapy of left ventricular thrombus

作　　者：陈学甫 张新鑫 司金萍 刘莹[1] CHEN Xuefu;ZHANG Xinxin;SI Jinping;LIU Ying(Department of Cardiology,the First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning 116021,China)

机构地区：[1]大连医科大学附属第一医院心血管内科,辽宁大连116021

出　　处：《中华实用诊断与治疗杂志》2024年第3期299-303,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82170385)。

摘　　要：左心室血栓(LVT)是急性心肌梗死和非缺血性心脏病的严重并发症,临床诊断主要依据患者病史、超声心动图和/或心脏磁共振检查提示心室内存在血栓性占位。近年来随着影像学技术的发展,LVT的诊断灵敏度及准确率明显提高。对急性心肌梗死后LVT,多数专家共识及指南推荐一线治疗应用以华法林为代表的维生素K拮抗剂,但利伐沙班、阿哌沙班等直接口服抗凝药预防及治疗LVT也具有较好的效果及安全性。目前尚无证据等级较高的非缺血性心脏病并发LVT防治的相关指南和专家共识。本文就LVT的流行病学特点、发生机制、诊断方法、抗凝药物选择的研究进展作一综述。Left ventricular thrombus(LVT)is a severe complication of acute myocardial infarction and non-ischemic heart diseases.The major clinical diagnostic basis of LVT includes thrombotic occupying lesion in left ventricle suggested by medical history,echocardiography and/or cardiac magnetic resonance imaging.In recent years,with the development of radiological technology,the diagnostic sensitivity and accuracy of LVT have been significantly improved.The majority of specialist consensus and guidelines have recommended vitamin K antagonists,represented by warfarin,as the first-line treatment medication of LVT after acute myocardial infarction.However,several studies showed that the efficacy and safety of directed oral anticoagulants as rivaroxaban and apixaban for LVT prevention and treatment are even better than warfarin.Currently,there is lack of high-level evidence-based guidelines and specialist consensus for prevention and treatment of LVT in non-ischemic heart diseases.This paper reviews the research progress of the epidemiology,mechanisms,diagnostic methods,and anticoagulant option of LVT.

关 键 词：左心室血栓 急性心肌梗死 非缺血性心脏病 维生素K拮抗剂 直接口服抗凝药 

分 类 号：R542.22[医药卫生—心血管疾病]