新型口服抗凝药对急性心肌梗死后心力衰竭合并室壁瘤附壁血栓消退影响的研究

The impact of novel oral anticoagulants on the regression of ventricular aneurysm mural thrombi in patients with heart failure following acute myocardial infarction

目的:探讨新型口服抗凝药(novel oral anticoagulants,NOAC)用于治疗急性心肌梗死(acute myocardial infarction,AMI)后心力衰竭合并室壁瘤内附壁血栓的疗效。方法:入选2019年6月至2023年5月,首都医科大学附属北京安贞医院心内科门诊和病房患者中AMI后发生心力衰竭合并室壁瘤内附壁血栓患者118例,分别给予NOAC(NOAC组,65例)或维生素K受体拮抗剂(VKA组,53例)治疗,3个月后复查经胸超声心动图,如血栓尚未完全溶解,则在首次给药6个月后再次复查超声心动图。结果:NOAC组中,使用利伐沙班治疗者为46例,使用达比加群治疗者为19例,治疗3个月后血栓完全溶解率为70.8%。所有VKA组患者均使用华法林治疗,3个月后血栓完全溶解率为67.9%,与NOAC组相比差异无统计学意义(P>0.05)。治疗6个月后,NOAC组的血栓完全溶解率为90.8%,VKA组的血栓完全溶解率为84.9%,两组血栓溶解率对比差异无统计学意义(P>0.05)。结论:NOAC可考虑作为AMI后心力衰竭合并室壁瘤内附壁血栓消退的治疗药物,且无须监测INR,使用方便,安全性好。

Objective:To investigate and compare the therapeutic effect of novel oral anticoagulants(NOAC)with vitamin K antagonists for ventricular aneurysm mural thrombi in patients with heart failure following acute myocardial infarction(AMI).Methods:We studied 118 patients with ventricular aneurysm mural thrombi and heart failure after AMI from June 2019 to May 2023 in department of cardiology,Beijing Anzhen Hospital of Capital Medical University,65 of them were treated with NOAC,and 53 with Vitamin K antagonists(VKA).Transthoracic echocardiography was repeated three months later.The resolution of thrombus will be reassessed with a repeat echocardiography at 6 months post-treatment if complete dissolution has not been achieved.Results:In the NOAC group,46 patients were prescribed with rivaroxaban and 19 with dabigatran.all VKA group patients were given warfarin.Complete thrombus resolution rate was 70.8%in the NOAC group and 67.9%in the VKA group at 3 months post-treatment.There was no significant disparity between the two groups(P>0.05).Complete thrombus resolution rate was 90.8%in the NOAC group and 84.9%in the VKA group at 6 months post-treatment.There was no significant disparity between the two groups(P>0.05).Conclusions:NOAC can be used as an effective alternative therapy option for the treatment of ventricular aneurysm mural thrombi in patients with heart failure after myocardial infarction and it does not need the surveillance of INR with the advantage of easy control and high security.