减量阿哌沙班治疗心房颤动/扑动的危险--一份病例报告及简要文献综述。

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
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引用次数: 0

摘要

心房颤动/心房扑动(房颤)患者由于心脏左心房内血栓的形成而极易发生血栓栓塞事件。房颤伴有相当不错的 CHA2DS2-VASc 评分是全面抗凝的一个已知指征,通常使用直接口服抗凝剂 (DOAC),如阿哌沙班。经过大量权衡抗凝获益与大出血风险的研究,符合两个或两个以上减量标准(年龄≥80 岁、体重≤60 千克和/或肌酐≥1.5 毫克/分升)的患者需要适当减量服用阿哌沙班。然而,随着对出血并发症的日益关注,许多医生发现,尽管患者并不完全符合所定义的标准,但他们仍在减少阿哌沙班的剂量。我们的研究特别强调,无论是适当还是不适当减少阿哌沙班剂量的患者,在抗凝治疗不足的情况下,血栓栓塞并发症的风险都会显著增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perils of reduced dose apixaban in atrial fibrillation/flutter – A case report with a brief literature review

Patients with atrial fibrillation/atrial flutter (AF) are notoriously predisposed to thromboembolic events secondary to the development of thrombi within the left atrium of the heart. AF accompanied by a fairly decent CHA2DS2-VASc score is a known indication for full anticoagulation, frequently with direct oral anticoagulants (DOACs), such as apixaban. Following extensive studies weighing the benefits of anticoagulation versus risks of major bleeding, patients meeting two or more of the dose-reduction criteria (age ≥80 years, weight ≤60 kg, and/or creatinine ≥ 1.5 mg/dL) require appropriate step-down to a reduced dose of apixaban. However, with rising concern for bleeding complications, many physicians are found to have been reducing the dose of apixaban despite the patient not completely meeting the defined criteria. Our study particularly emphasizes the risk of significantly increased thromboembolic complications in the setting of sub-therapeutic anticoagulation, in patients with both appropriately and inappropriately reduced doses of apixaban.

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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
303
审稿时长
1.5 months
期刊介绍: The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI). The SSCI is dedicated to the advancement of medical research and the exchange of knowledge, information and ideas. Its members are committed to mentoring future generations of medical investigators and promoting careers in academic medicine. The AJMS publishes, on a monthly basis, peer-reviewed articles in the field of internal medicine and its subspecialties, which include: Original clinical and basic science investigations Review articles Online Images in the Medical Sciences Special Features Include: Patient-Centered Focused Reviews History of Medicine The Science of Medical Education.
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