心力衰竭患者血液高凝状态的机制及抗栓治疗

Mechanisms of Hypercoagulability and Antithrombotic Therapy in Heart Failure Patients

心力衰竭患者存在血液高凝状态,其脑卒中及血栓栓塞事件较非心力衰竭患者发生率高。心力衰竭患者的血栓形成与纤溶系统激活、血小板活化、内皮细胞损伤、炎症等多种因素有关。多项临床试验研究表明,抗凝或抗血小板治疗可明显改善心力衰竭患者的预后,降低病死率,但抗栓治疗需评估其出血风险,尤其是对窦性心律心力衰竭患者。新型抗口服抗凝药的出现为心力衰竭患者的临床治疗提供了新的选择,但其疗效和安全性仍需大量研究评估。

There is a hypercoagulable state in heart failure patients,which have a higher prevalence of thromboembolism events and stroke.Fibrinolytic activity,platelet activation,endothelial dysfunction and inflammation may play an important role in the prothrombosis of heart failure.Many clinical trials suggest that,anticoagulation or antiplatelet therapy can obviously improve the prognosis of patients with heart failure,reduce mortality,though the risk of bleeding of antithrombotic therapy needs to be assessed,especially for patients with heart failure in sinus rhythm.The appearance of new oral anticoagulants provides a new choice for the clinical treatment of patients with heart failure,but a lot of research still needs to be done to evaluate its efficacy and safety.