新型口服抗凝药对心力衰竭合并左心室血栓患者的疗效研究

目的:探讨新型口服抗凝药(NOAC)用于心力衰竭合并左心室血栓患者的疗效。方法:入选2017年1月至2020年6月在首都医科大学附属北京安贞医院心力衰竭中心门诊和住院患者中明确诊断为心力衰竭合并左心室血栓患者100例,分别给予NOAC(NOAC组,42例)或维生素K受体拮抗剂(VKA组,58例)治疗,3个月后复查经胸超声心动图。结果:两组患者在年龄、性别、心血管危险因素和基础疾病、左心室射血分数等方面的差异均无统计学意义(P均>0.05)。在NOAC组,利伐沙班治疗者30例,达比加群治疗者12例,3个月时血栓完全溶解率为69.0%。所有VKA组患者均使用华法林治疗,血栓完全溶解率为63.8%,与NOAC组相比差异无统计学意义(P>0.05)。3个月期间,两组均未发生栓塞事件和致死性大出血事件,仅VKA组有2例胃肠道出血,对症治疗后即好转。结论:NOAC可考虑作为心力衰竭合并左心室血栓患者的治疗药物。

The Effect of Novel Oral Anticoagulants in Patients With Heart Failure and Left Ventricular Thrombi

Objectives:To investigate and compare the therapeutic effect of novel oral anticoagulants(NOAC)with vitamin K antagonists for left ventricular thrombi in heart failure patients.Methods:A total of 100 patients diagnosed definitively with heart failure and left ventricular thrombi from January 2017 to June 2020 in our Heart Failure Department were enrolled in our study,42 of them were treated with NOAC,and the others with Vitamin K antagonists(VKA).Transthoracic echocardiography was routinely repeated after three months.Results:There were no significant differences in age,gender,cardiovascular risk factors,baseline diseases,and left ventricular ejection fraction between two groups(all P>0.05).In the NOAC group,30 patients were prescribed with rivaroxaban,12 with dabigatran,and the total resolution rate was 69.0%at three-month follow-up.In the VKA group,all patients were given warfarin,and the total resolution rate was 63.8%(P>0.05).During the three-month,there were no thromboembolic events or fatal haemorrhage events in these patients.Only two patients in VKA group suffered from gastrointestinal bleeding,and recovered immediately after symptomatic therapy.Conclusions:NOAC may be considered as an effective alternative therapy option for the treatment of left ventricular thrombi in heart failure patients.