慢性心力衰竭的抗凝治疗

Anticoagulant Therapy for Chronic Heart Failure

慢性心力衰竭(CHF)患者的栓塞事件增加,然而抗凝治疗在CHF患者中的应用却充满着争议。CHF患者抗凝治疗的临床证据缺乏,华法林对心力衰竭(简称心衰)合并心房颤动的患者有益,但未能证实心衰常规抗凝治疗有获益。目前的临床随机对照研究认为,阿司匹林对血管紧张素转化酶抑制剂有拮抗作用而增加心衰患者的心衰再住院率。此综述的目的是阐明CHF患者的血栓事件发生率,以及抗凝治疗对CHF患者的临床获益与风险。

Patients with chronic heart failure（CHF） are at increased risk of thromboembolic events. How- ever,there is much debate and uncertainty over the use of antithrombotic therapy in these patients. The evi- dence for anticoagulation is limited. Warfarin is of proven efficacy in patients with heart failure and atrial fibrilllation, but there has been little research testing antithrombotic agents in patients of heart failure. Aspirin may be detrimental for heart failure due to a possible interaction with angiotensin-converting enzyme inhibitors, leading to increased hospitalization from decompensated heart failure. The objective of this review is to summa- rize the available evidence regarding the risk of stroke and thromboembalic events in CHF patients, as well as the effectiveness and risks of antithrombotic therapy in these patients.