Changes in cardiac thrombus status after cerebral ischemia.
Changes in cardiac thrombus status after cerebral ischemia.
复制标题
脑缺血后心脏血栓状态的变化。
DOI：
10.1159/000075788
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Oppenheimer,StephenM
中科院分区：
文献类型：
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作者：
Sen,Souvik;Lima,JoaoAC;Oppenheimer,StephenM
背景和目的心内血栓是脑栓塞的潜在来源。缺血性卒中/短暂性脑缺血发作（TIA）患者的心内血栓的处置进行了研究，在10个月的时间内使用全平面经食管超声心动图（TEE）。方法105例患者进行了TEE检查，在< 1个月，并再次在9-12个月（平均10个月）后症状发作。评价TEE的左心房、左心耳和左心室血栓。在随访TEE中比较有和无新血栓的患者的卒中危险因素和TEE结果。在随访TEE中对血栓消失和未消失的患者进行了类似的比较。抗凝剂的效果evaluated.ResultsIntracardiac血栓最初被发现在18%（95%CI 11-25%）的患者在79%（95%CI 61-97%）的血栓消失的后续TEE，这显着相关华法林抗凝（p= 0.037）。在其余82%（95% CI 75-89%）的患者中，8%（2-14%）的患者在随访TEE中检测到新血栓。这些患者年龄较大（p= 0.009），且未接受抗凝治疗。主动脉粥样硬化直径≥ 4 mm的患者也更有可能发展新的心内血栓（p= 0.001）.ConclusionsAnticoagulation与华法林10个月与脑缺血事件后导致心内血栓消失的条件相关，因此具有可能的治疗作用。未抗凝的老年患者和主动脉粥样硬化≥ 4 mm的患者发生新发血栓的可能性增加。这些患者可能存在心脏栓塞风险，可考虑进行预防性抗凝治疗。
Background and PurposeIntracardiac thrombi are a potential source of cerebral embolism. The disposition of intracardiac thrombi in ischemic stroke/transient ischemic attack (TIA) patients was investigated over a 10-month period using omniplanar transesophageal echocardiography (TEE).MethodsOne hundred and five patients underwent TEE examination at< 1 month and again at 9–12 months (mean 10 months) after symptom onset. TEEs were evaluated for thrombi in the left atrium, left atrial appendage and left ventricle. Stroke risk factors and TEE findings were compared between patients with and without new thrombi on follow-up TEE. Similar comparisons were made in patients with and without disappearance of thrombi on the follow-up TEE. The effect of anticoagulants was evaluated.ResultsIntracardiac thrombi were found initially in 18%(95% CI 11–25%) of patients in 79%(95% CI 61–97%) of whom the thrombi disappeared on the follow-up TEE; this significantly correlated with warfarin anticoagulation (p= 0.037). In the remainder 82%(95% CI 75–89%) patients, new thrombi were detected on the follow-up TEE in 8%(2–14%). These were older (p= 0.009), and not on anticoagulation. Patients with aortic atheroma≧ 4 mm were also more likely to develop new intracardiac thrombi (p= 0.001).ConclusionsAnticoagulation with warfarin for 10 months is associated with conditions leading to disappearance of intracardiac thrombi after a cerebral ischemic event and hence has a probable therapeutic role. Older patients, not anticoagulated, and those with significant aortic atheroma≧ 4 mm may have increased probability for de novo thrombus development. These patients may be at risk of cardiac embolization and could be considered for prophylactic anticoagulation.