急性心肌梗死经皮冠状动脉介入治疗后左心室附壁血栓患者的循证治疗

Evidence-Based Treatment for Post-PCI Patients with Left Ventricular Mural Thrombus after Acute Myocardial Infarction

目的利用循证医学的方法探讨急性心肌梗死经皮冠状动脉介入治疗后左心室附壁血栓患者的治疗方案及其可行性。方法根据患者临床情况提出问题,搜索PubMed(1990年1月至2009年7月)、OVID(1990年1月至2009年7月)、EMBASE(1990年1月至2009年7月)和CNKI(1994年至2009年7月)中文数据库中有关心肌梗死经皮冠状动脉介入治疗后加用抗凝药物(华法林)的相关文献,并对文献进行评价。结果纳入评价了25篇相关文献,分析后结合患者临床情况制订出三联疗法方案,经过10个月的随访证实该方案对患者安全有效。结论对于急性心肌梗死经皮冠状动脉介入治疗后左心室附壁血栓患者,在充分衡量获益及出血风险后,再按个体化原则给予三联疗法能获得良好疗效。

Objective To discuss the therapeutic regimen and its practicability for the post-PCI patients with left ventricular mural thrombus after acute myocardial infarction by the method of evidence-based. Methods Based on the patient＇s condition and questions, we searched for literatures about using anticoagulants（Warfarin） in post-PCI patients after myocardial infarction in PubMed （January 1990 to July 2009）, OVID （January 1990 to July 2009）, EMBASE （January 1990 to July 2009） and CNKI（1994 to July 2009）, and evaluated the evidence. Results Totally 25 literatures were studied, and according to the patient＇s condition, the triple therapy was introduced, and the therapy was approved to be safe and effective in the patient after 10 months follow-up. Conclusion After assessing the benefit to cardiac events and risk of bleeding, the triple therapy with individual principle is favorable for the post-PCI patients with left ventricular mural thrombus.