房颤引发的血栓要怎样预防?
心房颤动简称房颤,是心内科常见的心律失常,房颤患者的卒中风险是窦性心律患者的5倍以上,所以,房颤抗凝可预防心源性卒中,也是房颤治疗的关键。
口服抗凝药物华法林需是目前抗凝的常规方法,也占据了抗凝治疗的大多数,心源性卒中也随着抗凝大幅度减少。
对于房颤引发的血栓,我们预防有哪些方法呢?
1.新型抗凝药物
新型抗凝药物如利伐沙班、阿哌沙班、达比加群等。因服药后药理作用可预测而不需常规监测凝血功能,且相关研究证据表明,新型抗凝药物在预防卒中方面不劣于华法林,而且药物和食物相互作用更少,起效和失效快,所以新型抗凝药物被寄予厚望。但目前上市的新型抗凝药物价格不菲,也影响了其在患者中的应用。
2.房颤射频消融
房颤导管射频消融术是一种非外科手术治疗技术,它可以通过介入射频消融的方法将引起快速心律的异常心脏电传导通路破坏掉,大多数房颤可以经过射频消融治疗得到根除。房颤消失之后其产生血栓的环境消失,血栓随之消失,从而达到预防卒中的目的。但其有相对适应症和禁忌症,且因开展技术要求较高,仅限于国内较大心脏中心可行房颤射频消融手术。
3.内科介入左心耳封堵术
左心耳结构独特,是一个带钩的长管状结构,因其独特结构以及内膜面丰富的肌小梁决定了其结构内容易造成血流淤滞,从而形成血栓,研究显示非瓣膜病房颤患者左房血栓90%以上存在于左心耳,而通过内科介入封堵左心耳可消除其形成血栓的场所从而预防血栓的形成,从而降低房颤患者由血栓栓塞而引起的卒中风险,所以,左心耳封堵治疗方案为患者提供治疗新选择,但因其刚刚起步,有待于更多的临床证据支持。
4.外科途径封堵左心耳
外科途径封堵左心耳机制和内科相同,因其创伤较大,所以单纯为封堵左心耳的外科手术尚未开展,多见于患者需要行心脏外科手术同时封堵左心耳,故常在心脏大手术时被提及。
当然,为何华法林抗凝仍然备受推崇,主要还是其临床证据最足,相关临床试验最多,也是最为经济适用的方法。而其他相关方法,随着相关试验证据的越来越多,相信其成功推广或者应用也指日可待。
本文由作者原创,文章内容仅供参考。转载及合作事宜可联系jdh-hezuo@jd.com
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