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JACC Cardiovasc Interv：左心耳封堵与直接口服抗凝剂预防房颤患者血栓栓塞的优劣对比！

2021-01-11 xiaozeng MedSci原创

关注

房颤（AF）是一个重要的健康挑战，发病率越来越高，预计2030年仅美国就可以有1210万AF患者。房颤患者容易产生心源性血栓，血栓脱落后随血流至脑血管，可引发卒中。

房颤（AF）是一个重要的健康挑战，发病率越来越高，预计2030年仅美国就可以有1210万AF患者。房颤患者容易产生心源性血栓，血栓脱落后随血流至脑血管，可引发卒中。左心耳封堵术(LAAO)已被证明在预防房颤患者发生卒中的效果不逊于华法林。然而，目前直接口服抗凝剂(DOAC)比华法林更受欢迎用于房颤患者预防血栓形成。

本研究旨在对比左心耳封堵术(LAAO)与直接口服抗凝剂(DOAC)治疗高危型房颤患者的临床预后。本研究纳入了在Amulet观察登记处登记的1088位成功进行了LAAO的房颤患者，其中1078位采用的是Amplatzer Amulet设备；与1184位接受DOAC治疗房颤患者进行比较。两个队列的倾向性评分相互匹配，该评分是基于CHDS-VASc和ASBLED评分的协变量来预测卒中和出血。主要预后指标是缺血性卒中、大出血(出血学术研究联盟≥3)或全因死亡的综合结果，随访时间为2年。

主要预后

研究结果显示，接受LAAO治疗的房颤患者与接受DOAC治疗的患者相比，发生主要综合预后的风险显著降低(危险比[HR] 0.57；95%CI 0.49-0.67)。LAAO vs DOAC队列每100患者年的总事件和事件发生率分别为256 vs 461和14.5% vs 25.7%。两组之间缺血性卒中的风险相近(HR 1.11；95%CI 0.71-1.75)，但接受LAAO治疗的患者发生大出血(HR 0.62；95%CI 0.49-0.79)和全原因死亡率(HR 0.53；95%CI 0.43-0.64)的风险显著降低。

次要预后

综上，对于高危型房颤患者，LAAO与DOAC相比可能具有相近的卒中预防效果，但发生大出血和死亡的风险更低。

Nielsen-Kudsk Jens Erik,Korsholm Kasper,Damgaard Dorte et al. Clinical Outcomes Associated With Left-Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation. JACC Cardiovasc Interv, 2021, 14: 69-78.

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    2021-06-11 quxin068

    #ASC#

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    2021-07-16 hbwxf

    #JACC#

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    2021-01-16 ms5000002046661949

    手术封堵更好

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    2021-01-13 gdsun

    #口服抗凝剂#

    0

  5. 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    2021-01-13 12498568m50暂无昵称

    #ACC#

    0

  6. 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    2021-01-13 若水124

    #直接口服抗凝剂#

    0

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    2021-01-13 jxrzshh

    #左心耳#

    0

  8. 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    2021-01-13 hittouch

    #房颤患者#

    0

  9. 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    2021-01-12 Lizhihua6

    JACC Cardiovasc Interv：左心耳封堵与直接口服抗凝剂预防房颤患者血栓栓塞的优劣对比！

    0

  10. 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href='/topic/show?id=180d10411616' target=_blank style='color:#2F92EE;'>#左心耳封堵与直接口服抗凝剂预防房颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104116, encryptionId=180d10411616, topicName=左心耳封堵与直接口服抗凝剂预防房颤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Tue Jan 12 12:38:01 CST 2021, time=2021-01-12, status=1, ipAttribution=)]
    2021-01-12 zb1235672

    #左心耳封堵与直接口服抗凝剂预防房颤#

    0

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