摘要
目的：探讨心肌梗死伴发左室血栓患者抗栓治疗的有效性和安全性。
方法：选择2008年1月至2009年12月在浙江大学医学院附属第一医院心内科住院治疗的心肌梗死伴发左室血栓患者,根据不同的用药方案将其分为三联抗栓治疗组(华法令+阿司匹林+氯吡格雷)和双联抗血小板治疗组(阿司匹林+氯吡格雷)。通过电话回访及邀请部分患者来院复诊,获取患者出院后1-2年内左室血栓变化、治疗方案变更以及出血、缺血等临床事件的信息。
结果：2008年1月至2009年12月共有12位心肌梗死伴发左室血栓的患者在浙江大学医学院附属第一医院心内科住院治疗。其中1位患者在心梗发病5天后因严重心衰去世,1位在出院后5个月因膀胱癌去世,1位失访,7位患者接受三联抗栓治疗,余2位患者接受双联抗血小板治疗。三联抗栓治疗组6位患者的左室血栓在接受三联治疗后3个月内消失,另1位患者的血栓在第5个月时消失。双联治疗组2位患者的血栓均在第5个月的时候消失。治疗伊始,三联治疗组的6位患者和双联治疗组的2位患者接受了4-7天的短期那屈肝素抗凝治疗,两组的用药时间无明显差异。住院期间,三联治疗患者的国际标准化比值(INR)为1.912.83。出院后3个月内5位三联治疗患者的INR波动于2.25-2.79之间。出院后的1-2年内,除三联治疗组1名患者发生心源性猝死外,两组其余患者均未出现主要出血或缺血事件,也未出现左室血栓复发。
结论：对于不存在出血高危因素的心肌梗死伴发左室血栓患者,采用不超过三个月的三联抗栓治疗或许是安全和有效的,而INR的良好控制是减小出血风险的关键。
Objective Analyze the use of triple antithrombotic therapy in myocardial infarction (MI) patients who complicated with left ventricular thrombus (LVT), and investigate the efficacy and safety of triple therapy.
Methods The MI inpatients in The First Affiliated Hospital of School of Medicine in Zhejiang University between January 2008 and December 2009 were reviewed, and the patients who complicated with LVT were selected. According to their different oral medication exposure, the patients were divided into two groups:triple antithrombotic therapy (TT. warfarin plus aspirin and clopidogrel) and dual antiplatelet therapy (DT. aspirin plus clopidogrel). All patients were interviewed through telephone call, and the information about bleeding and other clinical events during the treatment period were collected and analvzed.
Results In The First Affiliated Hospital of School of Medicine in Zhejiang University, there were 12 MI patients who complicated with LVT between January 2008 and December 2009. One of them died in 5 days after MI because of severe heart failure, one died in 5 months after discharged because of bladder cancer, one was out of contact, seven patients received triple antithrombotic therapy and the other two received dual antiplatelet therapy. In TT group, six (6/7) patients'LVT disappeared in 3 months, and the other one's (1/7) LVT disappeared after treating for five months. In DT group, two (2/2) patients'LVT disappeared at the 5th months. Most of these patients (2 in DT and 6 in TT) received a short-term (4-7 days) nadroparin therapy for anticoagulation. The international normalized ratio (INR) in TT group in hospital was at the range of 1.91～2.83, and the INR of patients when undergoing triple therapy in three months after discharged was 2.25～2.79. There was no major bleeding or ischemic event happened in both two groups, except one sudden death in TT group.
Conclusion Triple antithrombotic therapy (no more than 3 months) might be safe and effective to MI patients who complicated with LVT, and the good control of INR is very important to help reducing the bleeding risk of triple therapy.
引文
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