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

作　　者：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] Yu Yahong;Liu Xiaocheng;Liu Zhigang;Song Yu;Wang Wei;Jia Kegang;Zhang Yunqiang;Wang Zhengqing(Department of Pharmacy,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiac Surgery,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Coronary Care Unit,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Intensive Care Unit,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Clinical Laboratory,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[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

出　　处：《中华心血管病杂志》2024年第5期500-504,共5页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2017YFC0111005)。

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。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 

分 类 号：R541.6[医药卫生—心血管疾病]