非维生素K拮抗剂口服抗凝药物治疗心室附壁血栓形成的探究

Investigation of Non-Vitamin K Antagonist Oral Anticoagulants for Treatment of Ventricular Mural Thrombus

心室附壁血栓最常见于左心室,常发生于心肌梗死后。对发生心室附壁血栓的患者,虽无明确的指南推荐抗凝药物的选择,在临床上仍普遍应用华法林治疗。然而,由于华法林本身存在一定的局限性,患者的依从性往往不佳。非维生素K拮抗剂口服抗凝药物(NOACs)以起效快、不易受食物及药物的影响、具有较稳定的抗凝活性、无需频繁实验室监测的特点而被尝试作为治疗心室附壁血栓的替代药物。到目前为止,NOACs对心室附壁血栓形成的治疗作用尚无大型随机对照试验的结果。现就NOACs治疗心室附壁血栓的有效性和安全性进行阐述。国内外研究和指南显示,应用NOACs治疗后血栓完全消退率高,血栓栓塞或出血并发症发生率低,故NOACs(包括Xa因子抑制剂和直接凝血酶抑制剂)可能是治疗心室附壁血栓的不错选择,尤其是对于不适合华法林抗凝治疗的患者,临床医师可根据患者个体情况有指征地选择NOACs进行抗凝治疗,从而缩短患者住院时间,减少并发症,提高生活满意度。

Ventricular mural thrombus is most common in the left ventricle and often occurs after myocardial infarction.Although there are no clear guidelines recommending the choice of anticoagulant for patients with ventricular mural thrombus,warfarin is still commonly used in clinical practice.However,due to the limitations of warfarin,patients'compliance is often poor.Non-vitamin K antagonist oral anticoagulants(NOACs)have been attempted as an alternative drug for the treatment of ventricular mural thrombus because of its rapid onset of action,fewer interaction with food and medications,more stable anticoagulation activity and the no need of frequent laboratory monitoring.So far,there is no large randomized controlled trial on the therapeutic effect of NOACs on ventricular mural thrombus.This article reviews the efficacy and safety of NOACs in the treatment of ventricular mural thrombus.Studies and guidelines at home and abroad show that the complete regression rate of thrombus is high and the incidence of thromboembolism or bleeding complications is low after treatment with NOACs.Therefore,NOACs(including Xa factor inhibitors and direct thrombin inhibitors)may be a good choice for the treatment of ventricular mural thrombus,providing clinicians with alternative anticoagulation therapy for individual patients,especially those who are not suitable for warfarin anticoagulation,thus shortening the length of hospital stay,reducing complications,and improving life satisfaction.