左心室血栓患者抗栓治疗的单中心回顾性分析  

Single-Center Retrospective Analysis of Antithrombotic Therapy in Patients with Left Ventricular Thrombus

作　　者：齐会红 李霞[2] 高新培 褚智君 付连浩 周航 缴万里[1] QI Huihong;LI Xia;GAO Xinpei;CHU Zhijun;FU Lianhao;ZHOU Hang;JIAO Wanli(Dept.of Pharmacy,Tangshan Gongren Hospital,Hebei Tangshan 063000,China;Dept.of Cardiology,Tangshan Gongren Hospital,Hebei Tangshan 063000,China)

机构地区：[1]唐山市工人医院药学部,河北唐山063000 [2]唐山市工人医院心内科,河北唐山063000

出　　处：《中国医院用药评价与分析》2024年第10期1196-1199,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：河北省医学科学研究课题计划(No.20241005);河北省药学会医院药学科研项目(No.2022-Hbsyxhms-11);唐山市科技计划项目(No.22150218J)。

摘　　要：目的:了解左心室血栓(LVT)患者抗栓治疗方案现状,并分析口服抗凝血药使用情况和LVT患者的临床转归情况,为LVT的治疗提供参考。方法:纳入2018年5月至2023年9月该院电子病历系统中诊断为LVT的患者,回顾性分析患者的抗凝血药使用情况,探讨抗凝治疗与非抗凝治疗、新型口服抗凝血药(NOAC)与华法林的血栓消退情况、血栓栓塞及出血事件发生情况。结果:共纳入156例患者,120例(占76.9%)患者接受抗凝治疗,其中接受NOAC治疗的患者为87例(占55.8%),接受华法林治疗的患者为33例(占21.2%)。抗凝组患者血栓栓塞事件发生率明显低于非抗凝组[5.0%(6/120)vs.16.7%(6/36),P=0.032],且未升高出血事件发生率[13.3%(16/120)vs.25.0%(9/36),P=0.094];NOAC组与华法林组患者血栓栓塞、出血事件发生率的差异均无统计学意义(P>0.05)。进一步分析106例有影像学资料患者的血栓转归情况,72例(占67.9%)患者的左心室血栓完全消退。抗凝组患者血栓消退率明显高于非抗凝组[72.4%(63/87)vs.47.4%(9/19),P=0.034],且血栓消退中位时间更短[48.0(32.0,120.0)d vs.(167.4±113.0)d,P=0.035],差异均有统计学意义。与华法林组比较,NOAC组患者血栓消退率相似,差异无统计学意义[71.4%(45/63)vs.75.0%(18/24),P=0.739];NOAC组患者血栓消退速度更快,差异有统计学意义[43.0(32.0,85.0)d vs.106.0(32.8,239.8)d,P=0.049]。结论:抗凝治疗可改善LVT患者血栓消退,减少血栓栓塞事件且不增加出血风险,但该院抗凝治疗比例仍有待提高。NOAC可考虑作为华法林的替代治疗,尤其是对华法林不耐受的患者。OBJECTIVE:To investigate the status of anti-thrombus treatment in patients with left ventricular thrombus(LVT),analyze the use of oral anticoagulant drugs and clinical outcomes of patients with LVT,so as to provide reference for the treatment of LVT.METHODS:Patients with LVT diagnosed in the medical record system of the hospital from May 2018 to Sept.2023 were included.The use of anticoagulant drugs was retrospectively analyzed.The thrombus resolution,thromboembolism events and bleeding events treated with anticoagulation or non-anticoagulation,new oral anticoagulant drugs(NOAC)or warfarin were investigated.RESULTS:A total of 156 patients were included,and 120 patients(76.9%)received anticoagulant therapy,including 87 patients(55.8%)treated with NOAC and 33 patients(21.2%)treated with warfarin.The incidence of thromboembolism events in the anticoagulation group was significantly lower than that in the non-anticoagulation group[5.0%(6/120)vs.16.7%(6/36),P=0.032],and the incidence of bleeding events was not increased[13.3%(16/120)vs.25.0%(9/36),P=0.094].There was no statistically significant difference in the incidence of thromboembolism events and bleeding events between the NOAC group and warfarin group(P>0.05).Further analysis of thrombus regression in 106 patients with imaging records showed complete regression of left ventricular thrombus in 72 patients(67.9%).The thrombus regression rate in the anticoagulation group was significantly higher than that in the non-anticoagulation group[72.4%(63/87)vs.47.4%(9/19),P=0.034],and the median time of thrombus regression was shorter than that in the non-anticoagulation group[48.0(32.0,120.0)d vs.(167.4±113.0)d,P=0.035],with statistically significant difference.The thrombus regression rate was similar between NOAC group and warfarin group,with no statistically significant difference[71.4%(45/63)vs.75.0%(18/24),P=0.739].Compared with the warfarin group,the thrombus regression rate was faster in the NOAC group,the difference was statistically significant[43.0(32.0,85.0)d

关 键 词：左心室血栓 抗凝 口服抗凝血药 新型口服抗凝血药 非维生素K拮抗剂 

分 类 号：R973.2[医药卫生—药品]