达比加群与华法林治疗急性心肌梗死合并左心室血栓形成的临床疗效

目的对比达比加群、华法林在急性心肌梗死合并左心室血栓(LVT)中的临床疗效。方法收集2015年9月—2020年3月辽宁省人民医院住院且诊断为急性心肌梗死合并左心室血栓的116例患者为研究对象,随机分为华法林组和达比加群组,观察各组患者卒中发生率、出血事件发生率、治疗前和治疗后3个月凝血功能指标、治疗前和治疗后1个月及3个月肝功能指标,并比较两组患者血栓消失时间、治疗期间新发血栓栓塞事件以及出血事件。结果治疗期间,达比加群组较华法林组总栓塞事件发生率较少(3.4%比24.1%,P=0.002),其中脑栓塞(1.7%比15.5%,P=0.016)差异具有统计学意义(P0.05);两组患者凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)比较差异无统计学意义(P0.05),达比加群组活化部分凝血活酶时间(APTT)高于华法林组,两组间比较差异有显著性(P0.05);两组患者治疗后1个月及3个月肝功能指标比较差异无统计学意义(P0.05);与华法林组比较,达比加群组血栓消失时间更短[(47.00±5.30)天比(69.10±7.90)天,P0.01],两组左心室血栓消失率相比,达比加群组明显多于华法林组(77.6%比39.7%,P=0.032);出血事件发生率达比加群组显著低于华法林组(3.4%比17.2%,P0.05)。结论对急性心肌梗死合并左心室血栓的患者,达比加群治疗较华法林更为安全有效。     

利伐沙班与华法林治疗左心室心尖部血栓的疗效比较

目的:比较利伐沙班与华法林治疗左心室心尖部血栓的疗效及安全性。方法:31例左心室心尖部血栓患者随机分为两组,华法林组(n=16例)患者初始治疗与低分子肝素合用,剂量2.5~3 mg,至国际标准化比值(INR)达2.0~3.0停用低分子肝素,继续维持华法林治疗,3天监测1次INR,共3次,INR稳定在2.0~3.0,以后每2周监测1次INR;利伐沙班组(n=15例)患者口服利伐沙班片剂10 mg,2次/d。随访时间3个月,比较两组患者血栓消失时间、治疗期间新发血栓栓塞事件以及出血事件。结果:两组患者在年龄、性别、合并疾病、血栓大小及药物治疗等方面差异均无统计学意义。与华法林组比较,利伐沙班组的血栓消失时间缩短[(60.00±5.50)d vs(71.00±8.50)d,P0.01];两组的新发血栓栓塞事件(脑栓塞、体循环栓塞)差异无统计学意义(P0.05),华法林组出血事件多于利伐沙班组,但差异也无统计学意义(P0.05)。结论:治疗左心室心尖部血栓利伐沙班较华法林起效更快,不增加出血风险。     

ACEI及ARB治疗老年慢性充血性心力衰竭患者左心室重构的临床疗效

目的比较血管紧张素转化酶抑制剂(ACEI)与血管紧张素Ⅱ受体阻滞剂(ARB)改善老年慢性充血性心力衰竭(CHF)患者左心室重构的疗效。方法选取60岁以上的初诊CHF患者134例,随机分为ACEI治疗者45例(ACEI组)、ARB治疗者48例(ARB组)及未使用ACEI或ARB治疗者(对照组)41例。在药物治疗前及治疗6个月后,三组分别进行NYHA心功能分级评估及超声心动图检测左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室质量指数(LVMI)。结果三组治疗前后NYHA心功能分级比较有统计学差异(P均<0.05)。治疗6个月,ACEI组、ARB组LVEF较对照组升高,LVEDD、LVMI较对照组下降;其中ACEI组LVESD、LVMI较ARB组进一步下降,差异均有统计学意义(P均<0.05)。结论 ACEI通过改善左心室重构进而治疗老年CHF,疗效优于ARB。     

左心室成形术治疗缺血性心力衰竭

目的:探讨并行循环下采用左心室成形术治疗缺血性心力衰竭的临床技术和经验,并报告中期疗效随访结果. 方法:回顾性分析2004年4月至2007年6月,我院心胸外科17例行左心室成形术的缺血性心力衰竭患者的临床资料.其中男性14例,女性3例,平均年龄(64±12.1)岁.既往有心肌梗死史12例,合并缺血性二尖瓣返流10例,合并左心室室壁瘤13例,合并左心室血栓4例.术前左心室射血分数(IVEF)为(29.1±6.4)%.术前心功能NYHA分级Ⅱ级5例,Ⅲ～Ⅳ级12例.17例缺血性心力衰竭的患者中,9例行左心室成形术+冠状动脉旁路术;6例行左心室成形术+冠状动脉旁路术+二尖瓣成形术;2例行单纯左心室成形术.4例合并左心室血栓者同时行左室血栓清除.全组患者均采用常温并行循环、左心引流,不阻断升主动脉,心脏跳动下完成左心室成形术.13例患者采用Dor手术进行左心室成形,4例患者采用改良线性缝合法进行室壁瘤切除+左心室成形.术后患者均接受门诊或电话随访. 结果:全组发生手术死亡1例,二次开胸止血1例.存活患者无严重围术期并发症发生.术后随访(12.7±6.1)个月,无失访例.随访期间中1例患者于术后3个月死于严重肺部感染.其余患者均存活,无心血管不良事件发生.术后患者IVEF平均为(42.8±7.2)%,较手术前明显改善(P<0.05).术后心功能NYHA分级T～Ⅱ级9例,Ⅲ级6例(P<0.05). 结论:并行循环下采用左心室成形术治疗缺血性心力衰竭安全可靠,中期随访疗效满意,但其对于患者心功能以及生存率的远期影响,尚有待进一步研究.     

卡维地洛对慢性心力衰竭患者左心功能的影响

目的观察卡维地洛对慢性充血性心力衰竭患者左心室收缩功能的影响。方法117例慢性心力衰竭患者分为卡维地洛组和对照组,用心脏超声诊断仪测量治疗前和治疗后1个月、3个月的心脏结构及功能。结果两组患者治疗1个月后左心室舒张末径、左心室舒张末容积、左心室收缩末容积,左心室射血分数与治疗前比较差异均无统计学意义(P>0.05);3个月及6个月时的上述指标与治疗前比较差异均有统计学意义(P<0.05)。结论卡维地洛可明显改善慢性心力衰竭左心室收缩功能。     

慢性心力衰竭患者心钠素、脑钠素浓度改变及卡维地洛对其影响

目的观察慢性心力衰竭患者心钠素、脑钠素浓度改变及卡维地洛对其影响.方法选择观察组慢性心力衰竭患者42例和对照组20例,采用放射免疫法测定治疗前后血浆心钠素、脑钠素浓度;彩色超声心动图测定左心室射血分数、左心室舒张末期内径;临床慢性心力衰竭采用NYHA心功能分级;将观察组随机分为常规治疗者21例和加用卡维地洛治疗者21例,满2周复查心钠素和脑钠素;满3个月复查彩色超声心动图.结果观察组血浆心钠素、脑钠素浓度均高于对照组(P均＜0.001);临床慢性心力衰竭程度越重,血浆心钠素、脑钠素浓度越高(P均＜0.001);卡维地洛治疗者与常规治疗者治疗满2周后均有血浆心钠素、脑钠素浓度下降,卡维地洛治疗者血浆心钠素、脑钠素浓度下降更明显(P＜0.05);而满3个月时卡维地洛治疗者左心室射血分数、左心室舒张末期内径均比常规治疗者明显改善(P均＜0.05).结论心钠素、脑钠素浓度可以反映心功能状态;卡维地洛可以降低心钠素、脑钠素浓度及改善心脏重构及心功能.     

不同血运重建策略对75岁以上女性缺血性心力衰竭患者的预后分析

目的:探究血运重建策略对年龄大于75岁的女性缺血性心力衰竭患者预后的影响。方法:选择我院年龄大于75岁女性缺血性心力衰竭患者,根据是否完全血运重建,分为部分血运重建组(partial revascularization group,PR组)与完全血运重建组(completely revascularization group,CR组)。分别于3个月、12个月返院行心脏彩超检查,对比两组患者病死率、左室射血分数,评价不同血运重建策略对年龄大于75岁的女性缺血性心力衰竭患者的疗效。结果:PR组27例,CR组40例,两组基线资料无统计学差异。3个月后,两组患者左室射血分数均得到有效的改善(PR∶CR为39.6%∶48.4%),P=0.004;一级不良事件无统计学差异,P=0.377;不良事件率无统计学差异(40.7%∶25.0%),P=0.287。随访至12个月,左室射血分数改善(PR∶CR为41.8%∶48.1%),P=0.008;一级不良事件无统计学差异,P=0.276;两组患者事件率无统计学差异(63.0%∶37.5%),P=0.082。结论:老年女性缺血性心力衰竭患者经积极完全血运重建能改善心脏功能,不能改善事件率,亦未能带来生存获益。     

伊伐布雷定治疗慢性阻塞性肺疾病合并心力衰竭患者的疗效观察

目的观察慢性阻塞性肺疾病(COPD)合并心力衰竭(HF)患者使用伊伐布雷定的有效性和安全性。方法连续入选2016年8月～2017年2月于空军军医大学唐都医院门诊及住院治疗的慢性阻塞性肺疾病合并心力衰竭患者62例,随机分为治疗组32例及对照组30例,治疗组患者在标准心衰治疗基础上,联用伊伐布雷定,而对照组仅给予标准心衰治疗。连续用药3个月,记录两组患者用药前后静息心率,N末端脑钠肽前体(NT-proBNP)水平、6 min步行试验距离和左心室射血分数(LVEF),同时随访患者3个月时间内出现的临床不良事件。结果治疗组及对照组患者基线资料无统计学差异。治疗3个月后,治疗组患者静息心率显著低于对照组(62.3±1.8 vs. 77.3±2.1)次/min,(P0.05),治疗组患者的LVEF及6 min步行试验距离均显著高于对照组,而NT-proBNP水平则低于对照组(P均0.05)。治疗组患者的平均住院时间显著低于对照组(8.5±1.7 vs. 10.2±2.1)d,(P0.05),而两组患者3个月时间内临床不良事件的发生率无统计学差异(P0.05)。结论对于慢性阻塞性肺疾病合并心力衰竭患者,伊伐布雷定可以有效控制静息心率,进一步改善患者心脏功能。     

肥厚性心肌病合并左心室血栓的临床分析

目的 探讨合并左心室血栓的肥厚性心肌病(HCM)患者的临床特征和预后.方法 回顾性分析阜外心血管病医院2002年1月至2012年12月住院患者中经心脏磁共振证实有左心室血栓的HCM患者的临床资料及随访情况.结果 经磁共振证实有左心室血栓的HCM患者共6例(血栓组),左心室无血栓的HCM患者共284例(无血栓组),血栓组患者的心血管病家族史、室性心律失常和室壁瘤比例明显高于无血栓组(66.67％比21.48％,66.67％比5.63％,66.67％比0.35％,均为P＜0.05),左心房内径、左心室内径明显大于无血栓组[(47.67±6.28) mm比(39.88 ±7.37)mm,(55.83±7.13)mm比(45.25±6.55)mm,均为P＜0.05],而左心室射血分数和流出道梗阻比例明显低于无血栓组(41.50％±18.50％比67.14％±9.47％,0比47.54％,均为P＜0.05).有左心室血栓的患者接受华法林抗凝治疗,随访17～59个月,未发现血栓栓塞,2例复查血栓消失,3例死亡,l例进行了全心脏移植.结论 HCM合并左心室血栓见于有室壁瘤或左心室射血分数减低的患者,多合并室性心律失常,预后较差;还可发生栓塞事件,华法林可有效治疗左心室血栓.     

心房颤动导管消融与药物治疗效果的比较研究

目的比较心房颤动(房颤)导管消融治疗与药物治疗的治疗效果。方法连续入选644例房颤患者,获取基线特征,应用倾向评分方法进行匹配分组,获得两组不同治疗策略的入选人群(257例),进行为期约18个月的随访,通过Cox比例风险模型比较导管消融和药物治疗对房颤患者一级终点房颤复发事件以及二级终点因心力衰竭住院率、血栓栓塞事件、累积生存率及生活质量改善的影响。结果 (1)无房颤复发终点:导管消融术组优于抗心律失常药物治疗组(HR:3.12,95%CI:1.93~5.03,P<0.01)。(2)因心力衰竭住院率:导管消融术组与抗心律失常药物治疗组差异无统计学意义(HR:1.14,95%CI:0.67~1.94,P=0.34)。(3)血栓栓塞事件发生率:在导管消融术组和抗心律失常药物治疗组间差异无统计学意义(HR:0.98,95%CI:0.44~2.20,P=0.38)。(4)累积生存率:两组间差异无统计学意义(HR:1.05,95%CI:0.33~3.32,P=0.73)。(5)生活质量评分:抗心律失常药物组生活质量无明显改善,而导管消融术组仅对精神方面评分有显著改善(随访3个月和12个月均为P=0.04)。结论导管消融治疗与药物治疗相比,房颤复发率更低,并可以改善精神方面的生活质量,但未能降低因心力衰竭住院率和血栓栓塞事件发生的风险,两种治疗手段的累积生存率差异无统计学意义。     

Assessment of non‐vitamin K antagonist oral anticoagulants for the management of left ventricular thrombus

Although several studies have assessed the effect of non‐vitamin K antagonist oral anticoagulants (NOACs) relative to that of vitamin K antagonists (VKAs) in patients with left ventricular thrombus, the results remain controversial. Herein, a meta‐analysis was performed to compare the effectiveness and safety of NOACs versus VKAs for the treatment of left ventricular thrombus. We systematically searched the Cochrane Library, PubMed and Embase databases until November 2020 for studies that compared the effects of NOACs versus VKAs in patients with left ventricular thrombus. The treatment effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled by a random‐effects model. Seven retrospective studies involving 865 patients with left ventricular thrombus (266 NOAC and 599 VKA users) were included. The pooled analysis suggested no difference in the rate of thrombus resolution between the NOAC and VKA groups (OR = 0.83, 95% CI 0.61–1.13). There were also no differences in the rates of stroke or systemic embolism (OR = 0.62, 95% CI 0.20–1.97), bleeding events (OR = 0.73, 95% CI 0.37–1.45), or all‐cause death (OR = 0.92, 95% CI 0.50–1.69) between patients treated with NOACs and those treated with VKAs. In addition, the rates of thrombus resolution, stroke or systemic embolism, bleeding events, and all‐cause death between NOAC‐ and warfarin‐treated patients were also similar. Our current evidence suggested that NOAC and VKA users had similar rates of thrombus resolution and clinical outcomes among patients with left ventricular thrombus. Further large‐scale prospective studies should confirm our results.     

Oral anticoagulation during atrial fibrillation ablation: Facts and controversies

On the background of population ageing atrial fibrillation (AF) has reached epidemic dimensions in developed countries. This condition is associated with major cardiovascular morbidity and mortality mainly due to its thrombo-embolic and heart failure related complications. Left atrial (LA) catheter ablation has emerged as a suitable alternative to antiarrhythmic drugs for sinus rhythm maintenance at least for paroxysmal atrial fibrillation in the settings of no/mild LA dilatation. Chronic oral anticoagulation (OAC) is helpful to prevent AF thromboembolic complications in high-risk patients. OAC is also protective around ablation procedures in patients with or without an indication for long-term OAC therapy, emphasizing a slight increase in periprocedural risk of stroke. Due to the potential catastrophic hemorrhagic complications during trans-septal LA instrumentation, traditional approach on LA ablations involved warfarin discontinuation with periprocedural heparin bridging. Recent observational data suggests that radiofrequency (RF) catheter ablation of AF under therapeutic OAC (mainly vitamin K antagonists [VKA]) may reduce the periprocedural risk of complications, mainly thromboembolic events (possibly including silent strokes). Uninterrupted OAC has been acknowledged as an alternative to heparin bridging by the recently published consensus and guidelines update on AF ablation. Currently the recommended therapeutic level of OAC during ablation is low (such as an INR of 2–2.5). In the general AF settings new OAC (NOAC) have shown non-inferiority compared to VKA for stroke prevention, with better safety. Rapidly acting NOAC seems a tempting alternative to VKA at least for the patients taken off OAC before the ablation, possibly avoiding any post-procedural heparin bridging. However, limited experience with periprocedural use of NOAC (mainly dabigatran) suggests an increased risk of bleeding or thromboembolic complications compared with VKA.     

Management and outcome of gastrointestinal bleeding in patients taking oral anticoagulants or antiplatelet drugs

Background

Non-vitamin K dependent oral anticoagulants (NOACs) significantly decrease overall major bleeding rates compared with vitamin K antagonists (VKAs) but there is conflicting evidence regarding the relative risk of gastrointestinal bleeding. Since data regarding the types, the management, and the outcome of NOAC-associated gastrointestinal bleeding are scarce, we aimed to fill this gap by comparing cases of gastrointestinal bleeding associated with NOAC, VKA, or antiplatelet therapy.

Methods

All major gastrointestinal bleeding events documented in the prospective Dresden NOAC registry were identified, and bleeding location, lesion type, endoscopic treatment, use of blood and coagulation factor transfusion, length of stay, and in-hospital mortality were compared with historical data from a large cohort of consecutive gastrointestinal bleeding patients.

Results

In the 143 NOAC therapy cases, upper gastrointestinal tract bleeding was seen in 44.1%, lower gastrointestinal tract bleeding was seen in 42.0%, and no lesion could be identified in the remaining 14.0%. In contrast, upper gastrointestinal tract bleeding was commoner in the 185 VKA therapy cases (53.0%) and in the 711 antiplatelet therapy cases (68.1%). Among cases with upper gastrointestinal tract bleeding during VKA or antiplatelet therapy, 54.1% and 61.4% respectively presented with ulcers, compared with 27.0% for NOAC therapy. In contrast, hemorrhoid bleeding was the predominant lesion type for lower gastrointestinal tract bleeding with NOAC therapy, with a rate of 33.3%, compared with 10.6% with VKA therapy and 8.7% with antiplatelet therapy. NOAC-associated gastrointestinal bleeding resulted in comparatively low resource consumption, shorter hospitalization, and low in-hospital mortality (1.6%) compared with gastrointestinal bleeding historically seen with use of VKAs (in-hospital mortality 5.6%) or antiplatelet agents (in-hospital mortality 11.9%).

Conclusions

Gastrointestinal bleeding in NOAC recipients is different from that seen with VKA or antiplatelet therapy and has a better short-term prognosis.

     

The optimal intensity of vitamin K antagonists in patients with mechanical heart valves: a meta-analysis

OBJECTIVES: The purpose of this study was to compare two different intensities of vitamin K antagonists (VKA) among patients with mechanical heart valves using meta-analytic techniques. BACKGROUND: Patients with mechanical heart valves are at increased risk for valve thrombosis and systemic embolism, which can be reduced by VKA. The range of optimal intensity of VKA is still a matter of debate. METHODS: A computerized search in the PubMed database was made for relevant articles. A meta-analysis was performed of all eligible studies with data on the incidences of thromboembolic and bleeding complications in patients with mechanical heart valve prostheses during different intensities of VKA therapy. The studies were classified into low-intensity VKA therapy (mean target international normalized ratio [INR] of 3.0 or lower) or high-intensity VKA therapy (mean target INR above 3.0). RESULTS: Thirty-five eligible studies were identified, including in total 23,145 patients, who were studied for 108,792 patient-years. For patients with an aortic valve, high intensity resulted in a lower incidence of thromboembolic events (risk ratio [RR] = 0.73, p < 0.0001); however, the incidence of bleeding was increased (RR = 1.23, p < 0.0001). In the mitral valve group, the incidence rate for thromboembolism was lower in the high-intensity group (RR = 0.74, p < 0.0001), without a significantly increased bleeding incidence (RR = 1.08, p = 0.0524). The total number of thromboembolic and bleeding events was decreased in the high-intensity group compared with low-intensity VKA therapy for both aortic and mitral valve prostheses (RR = 0.94 [p = 0.0067] and 0.84 [p < 0.0001]), respectively. CONCLUSIONS: This meta-analysis shows that both aortic and mitral valves will benefit from a treatment strategy with a target INR higher than 3.0.     

Therapiesicherheit bei Verwendung nicht Vitamin-K-abhängiger oraler Antikoagulanzien bei Patienten mit Vorhofflimmern

Non-vitamin K oral anticoagulants (NOAC) have now become established for stroke prevention in atrial fibrillation. The efficacy is at least as good if not better than that of vitamin K antagonists (VKA). The risk for major bleeding is less for NOAC than for VKA, with a particular superiority concerning the avoidance of intracerebral hemorrhage. The outcome after major bleeding is more favorable in patients receiving NOAC compared to those treated with VKA. Specific reversal agents for NOAC are currently being tested which neutralize the effects of NOAC within minutes and the clinical introduction of the first one for the thrombin inhibitor dabigatran is imminent. Such specific antidotes will further improve the safety profile of NAOC.     

心房颤动合并肥厚型心肌病患者服用NOAC的有效性和安全性评价

目的:评估心房颤动（房颤）合并肥厚型心肌病（HCM）患者服用非维生素K拮抗剂口服抗凝药（NOAC）的有效性与安全性。方法:本研究为前瞻性队列研究,数据来自前瞻性、多中心的中国房颤注册研究（CAFR）,CAFR研究从31家医院入选住院和门诊房颤患者。选取CAFR研究中2011年8月至2018年12月的房颤合并HCM患者。...     

Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation

Background

The study aimed to explore the resolution of left atrial and left atrial appendage (LAA) spontaneous echo-contrast or thrombus in patients with nonvalvular atrial fibrillation/flutter (AF/AFL) under chronic oral anticoagulation (OAC).

Methods

A single-center retrospective analysis of patients who underwent a transesophageal echocardiography (TOE) for an electrical cardioversion was conducted.

Results

Among 277 TOE performed, 73 cases (26%) of LAA echo-contrast or thrombus were detected, 53 patients with LAA/LA echo-contrast (19%) and 20 (7%) with a thrombus. All patients were under chronic anticoagulation with a VKA (65%) or with a NOAC (35%). The Echo-contrast Group maintained the same OAC strategy in 49 patients (93%). The Thrombus Group kept the same OAC strategy with a NOAC in 6 cases (30%) and changed the strategy in 14 patients (70%), titrating NOAC dose in 1 (5%) and the VKA dose in 4 (20%) and switching from NOAC to VKA in 5 (25%), from VKA to NOAC in 3 (15%), and from NOAC to NOAC in 1 (5%). Smoke resolution was observed in 4/40 cases (10%) of the smoke group and thrombus resolution in 8/15 (53%) of the thrombus group. Patients with thrombus resolution had a lower CHA2DS2-Vasc score (3.5?±?2 vs 4?±?1, p?=?0.05), were more often under NOAC (37.5 vs 28%, p?=?0.07), and had a longer anticoagulation time (7.5 vs 4 months, p?=?0.08).

Conclusion (s)

Changing OAC strategy is associated with thrombus resolution in more than 50% of chronically anticoagulated patients.

     

Neue orale Antikoagulanzien

The new oral anticoagulants (NOAC) are alternative drugs to classical vitamin K antagonists (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation. They have been shown in randomized trials to be superior to warfarin in reducing clinical endpoints, although at rather small effect sizes. However, in study centers with good anticoagulation management their superiority was barely significant. The effectiveness of anticoagulation therapy is crucially dependent on individual drug adherence. NOAC potentially decrease adherence due to several reasons, among them the twice-daily dosing requirement in some of them and the nonnecessity for anticoagulation monitoring. Anticoagulation monitoring is assumed to increase adherence per se. VKA are potentially better suitable to compensate for low adherence due to their long half-lives.     

Multiple left ventricular thrombi in a patient with left ventricular noncompaction

The major clinical features of myocardial noncompaction are heart failure, arrhythmias, and thromboembolic events. Prominent myocardial trabeculae and deep recesses characteristic of myocardial noncompaction can cause stagnant blood flow and the formation of left ventricular clots. We describe the case of a 62-year-old woman who presented with symptoms of heart failure secondary to left ventricular noncompaction. Transthoracic and transesophageal echocardiography revealed multiple left ventricular thrombi, which had formed despite the patient's long-term therapy with aspirin.Anticoagulative therapy should be considered for patients with myocardial noncompaction who also have risk factors for thromboembolism, such as atrial fibrillation, a history of systemic embolism, or severe left ventricular systolic dysfunction. However, chronic antiplatelet therapy may not sufficiently prevent clot formation in patients who have myocardial noncompaction and severe left ventricular systolic dysfunction.     

Management of Anticoagulant Therapy for Patients with Prosthetic Heart Valves or Atrial Fibrillation

There is a wide array of recommendations for the management of anticoagulant therapy in patients with mechanical heart valves. Especially the optimal intensity of vitamin K antagonists (VKA) is a ongoing matter of debate. On the basis of several studies, recommendations for daily clinical practice can be made. In this review, we discussed the studies and the different guidelines. Guidelines for the prevention of thromboembolic complications in patients with atrial fibrillation are more stringent. VKA with a target INR between 2.0 and 3.0 is more effective in the prevention of stroke than aspirin, especially in the presence of riskfactors for thromboembolism (age above 65, previous thromboembolism, history of hypertension and diabetes, enlarged left atrial diameter and left ventricular dysfunction). In the absence of clinical or echocardiographical riskfactors for thromboembolism, patients may be safely treated with aspirin.