心力衰竭患者的长期血栓预防;尚未满足的需求。

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Failure Reviews Pub Date : 2024-09-01 Epub Date: 2024-07-17 DOI:10.1007/s10741-024-10422-w
Majed S Al Yami, Abdulmajeed M Alshehri, Saeed M Alay, Abdulmalik Y Aljoufi, Mariam S Alsulimani, Shatha M Algarni, Sumaya N Almohareb, Awatif M Hafiz, Omar A Alshaya, Amal M Badawoud
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引用次数: 0

摘要

心力衰竭(HF)被认为是全球心血管疾病发病率和死亡率的主要原因之一。由于存在许多生理和血栓栓塞风险因素,多项研究都报道了心力衰竭与静脉血栓栓塞(VTE)之间的关联。因此,对高血压患者出院后延长血栓预防期的必要性进行了评估。由于血栓预防的益处不确定且出血风险增加,大多数指南都不建议延长血栓预防时间。然而,最近在心房颤动患者中发现的证据表明,延长血栓预防期不会增加出血风险,这就强调了识别可能受益于延长血栓预防期的理想人选的重要性。目前已开发出几种风险评估模型(RAMs),用于根据风险收益原则识别VTE高风险患者,这些患者将从院内和出院后的预防性抗凝治疗中获益。然而,这些方法在预测 VTE 方面的准确性值得怀疑,而且没有一种方法可用于评估高血压患者的 VTE 风险。在这篇综述中,我们概述了心房颤动患者 VTE 的发病率和病理生理学,总结了预防 VTE 的指南建议,并总结了评估延长血栓预防的研究,重点是心房颤动患者的亚组或事后分析。我们还讨论了设计理想 RAM 的必要性,该 RAM 可通过对 VTE 风险进行分层并确定包括心房颤动患者在内的内科病人出血的关键风险因素,从而确定延长血栓预防的候选患者。
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Extended thromboprophylaxis in heart failure patients; the unmet need.

Heart failure (HF) is considered one of a leading cause of cardiovascular morbidity and mortality worldwide. The association between HF and venous thromboembolism (VTE) has been reported in several studies owing to many physiological and thromboembolic risk factors. Thus, the need for extended thromboprophylaxis during the post-discharge period in HF patients has been evaluated. Most guidelines do not recommend extended thromboprophylaxis because of its uncertain benefits and increased risk of bleeding. However, recent evidence in HF patients revealed no increased risk of bleeding with extended thromboprophylaxis, which highlights the importance of identifying ideal candidates who might benefit from extended thromboprophylaxis. Several risk assessment models (RAMs) have been developed to identify patients at a high risk of VTE who would benefit from in-hospital and post-discharge prophylactic anticoagulation therapy based on the risk-benefit principle. However, their accuracy in predicting VTE is questionable, and none have a standardized approach for evaluating the risk of VTE in HF patients. In this review, we provided an overview of the incidence and pathophysiology of VTE in HF patients, a summary of guideline recommendations for VTE prevention, and a summary of studies evaluating the use of extended thromboprophylaxis, with a focus on subgroup or post-hoc analyses of HF patients. We also discussed the need to design an ideal RAM that can identify candidate patients for extended thromboprophylaxis by stratifying the risk of VTE and identifying the key risk factors for bleeding in medically ill patients, including those with HF.

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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
期刊最新文献
Adrenal crisis-induced cardiogenic shock (ACCS): a comprehensive review. Congestion/decongestion in heart failure: what does it mean, how do we assess it, and what are we missing?-is there utility in measuring volume? Treating heart failure by targeting the vagus nerve. The utility of urine sodium-guided diuresis during acute decompensated heart failure. Pharmacological management of heart failure in adults with congenital heart disease.
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