心房颤动患者发生抗凝相关出血后重启抗凝治疗的研究进展

Research progress on restarting anticoagulation therapy in patients with atrial fibrillation after anticoagulation-related hemorrhage

房颤最严重的并发症是血栓栓塞,脑卒中是最常见的表现类型,抗凝治疗能有效预防房颤相关的脑卒中事件,但同时也会增加出血的风险,一旦发生出血,恢复后是否需要重启抗凝治疗以及何时重启抗凝尚存在争议。抗凝治疗并发出血的房颤患者,血栓栓塞和复发出血的风险均增高,多数情况下,重启抗凝治疗依然有临床净获益。如何安全重启抗凝,需要临床医师充分评估患者血栓栓塞风险和再出血的风险,并结合患者临床特征综合考虑,选择个体化的重启抗凝策略。

The most serious complication of atrial fibrillation is thromboembolism, and cerebral apoplexy is the most common presentation type. Reasonable and standard anticoagulation treatment is an effective measure to prevent stroke related to atrial fibrillation. But at the same time, it will face the risk of bleeding. Once bleeding occurs, whether and when to restart anticoagulation after recovery are still controversial. In patients with atrial fibrillation complicated with hemorrhage because of anticoagulation therapy, the risk of thromboembolism and recurrent bleeding increased. In most cases, there is still a clinical net benefit of restarting anticoagulation therapy. How to restart anticoagulation safely requires clinicians to fully evaluate the risk of thromboembolism and re-bleeding, and to select individualized restart anticoagulation strategy based on the comprehensive consideration of clinical characteristics of patients.