Antithrombotic therapy for atrial fibrillation in hereditary hemorrhagic telangiectasia.
Antithrombotic therapy for atrial fibrillation in hereditary hemorrhagic telangiectasia.
复制标题
遗传性出血性毛细血管扩张症心房颤动的抗血栓治疗。
DOI：
10.1007/s11239-023-02839-1
复制
发表时间：
2023
影响因子：
4
通讯作者：
Al-Samkari,Hanny
中科院分区：
文献类型：
--
作者：
Virk,ZainM;Richardson,TLee;Al-Samkari,Hanny
抗血栓治疗降低房颤患者卒中风险，但以出血风险增加为代价。遗传性出血性毛细血管扩张（HHT）患者由于脆弱的粘膜皮肤毛细血管扩张和内脏动静脉畸形而出血风险增加。由于HHT的血管异常，这些患者同时处于血栓形成风险升高的状态。HHT患者心房颤动的管理是一个未被充分研究和具有挑战性的临床场景。我们提出了一项回顾性队列研究，调查HHT和房颤患者的抗血栓治疗。我们发现抗血栓治疗耐受性差，导致大多数患者和大多数治疗期过早减少剂量或停止治疗。5例接受左心房附件手术的患者，尽管难以完成手术后抗血栓治疗的规定疗程，但表现良好。左心耳闭塞或同时给予全身抗血管生成治疗可能是替代方案，但需要对HHT患者进行额外的研究。
Antithrombotic therapy reduces stroke risk in patients with atrial fibrillation but at the cost of increased bleeding risk. Patients with hereditary hemorrhagic telangiectasia (HHT) are at increased bleeding risk due to fragile mucocutaneous telangiectasias and visceral arteriovenous malformations. These patients are simultaneously at elevated thrombotic risk due to the vascular abnormalities of HHT. Managing atrial fibrillation in patients with HHT represents an understudied and challenging clinical scenario. We present a retrospective cohort study investigating antithrombotic therapy in patients with HHT and atrial fibrillation. We found that antithrombotic therapy was poorly tolerated, leading to premature dose-reduction or discontinuation of therapy in a majority of patients and in a majority of treatment episodes. Five patients undergoing left atrial appendage procedures did well despite difficulties completing the prescribed course of post-procedure antithrombotic therapy. Left atrial appendage occlusion or simultaneous administration of systemic anti-angiogenic therapy may represent alternatives but require additional study in patients with HHT.