A plea for a clinical trial of anticoagulation in dilated cardiomyopathy.
A plea for a clinical trial of anticoagulation in dilated cardiomyopathy.
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呼吁对扩张型心肌病进行抗凝临床试验。
DOI：
10.1016/0002-9149(90)91436-a
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Rodney H. Falk
中科院分区：
文献类型：
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作者：
Rodney H. Falk
弥漫性心肌病被认为是中风的诱发因素。对扩张型心肌病心脏的尸检研究表明，高达75%的病例存在心室血栓或附壁内膜斑块（认为是由于机化血栓所致）2全身栓塞的特征很常见，在生活中可能未被怀疑。虽然尸检数据代表了一个高度选择的亚组，但扩张型心肌病的回顾性研究表明，临床上明显的栓塞很常见，年发病率约为3.5%。建议使用华法林进行长期抗凝治疗以降低栓塞风险，“，3+ 4，但该结论是从选定的患者组中回顾性得出的，没有数据可用于估计非栓塞人群的风险-受益比。我个人的印象是，许多医生不愿意为扩张型心肌病患者开长期华法林。例如，在最近的一项研究中，40例扩张型心肌病患者中只有6例接受抗凝治疗。这种不情愿可能是因为缺乏令人信服的、前瞻性的风险-受益比数据。这也可能源于人们担心抗凝治疗对这组患者来说可能更危险--肝充血程度的波动可能会导致华法林需求的变化和出血风险的增加。”在过去的几年里，我们对急性心肌梗死后血栓栓塞及其预防的认识有了很大的扩展。心肌梗死和扩张型心肌病血栓形成之间存在重要差异。本文将讨论这些问题，以及评估和安全减少源于肌病心室的血栓栓塞事件的可能性。
D ilated cardiomyopathy is believed to be a pre-disposing factor for stroke.’Autopsy studies of hearts with dilated cardiomyopathy demonstrate the presence of ventricular thrombus or mural endocardial plaques (which are considered to be due to organized thrombi) in up to 75% of cases2 Features of systemic embolization are common and may not have been suspected during life. Although autopsy data represent a highly selected subgroup, retrospective studies in dilated cardiomyopathy suggest that clinically apparent embolism is common, occurring with an annual incidence of about 3.5%.’Long-term anticoagulation with warfarin has been recommended to reduce the risk of embolization,‘, 3+ 4 but this conclusion is retrospectively derived from selected patient groups and no data are available to estimate the risk-to-benefit ratio in an unselected population. It is my personal impression that many physicians are reluctant to prescribe long-term warfarin for their patients with dilated cardiomyopathy. For example, in a recent study only 6 of 40 patients with dilated cardiomyopathy were receiving anticoagulation. The reluctance may be because of a lack of convincing, prospectively derived data on the risk-to-benefit ratio. It may also stem from concern that anticoagulation may be more hazardous in this group of patients-in whom fluctuating degrees of hepatic congestion may result in changing warfarin requirements and an increased risk of bleeding.‘jT’In the past few years our knowledge of thromboembolism and its prevention after acute myocardial infarction has greatly expanded. Important differences exist between thrombus formation in myocardial infarction and dilated cardiomyopathy. They will be discussed herein, as will possibilities for assessing and safely reducing thromboembolic events originating from the myopathic ventricle.