Yoganiranjana Dharuman, Mirko Doss, Petar Risteski, Aron Frederik Popov
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引用次数: 0
摘要
治疗终末期心力衰竭的金标准疗法是心脏移植。然而,在供体短缺的情况下,左心室辅助装置 HeartMate 3(雅培实验室,美国伊利诺伊州雅培公园)等机械辅助装置可作为移植和/或终点治疗的桥接疗法。现行指南建议使用维生素 K 拮抗剂联合小剂量阿司匹林进行抗凝治疗。我们在此报告了一个具有挑战性的抗凝治疗方案,患者患有 HeartMate 3,由于兼容性低和罕见的 X 因子缺乏症,4 年来一直无法使用华法林进行全身抗凝治疗。这是一种罕见的血液病,据估计在普通人群中约每 500,000 到 1,000,000 人中就有一人患有这种疾病。患者最终接受了一种改良的抗凝治疗方案,其中包括利伐沙班和氯吡格雷的组合,而不使用华法林。在这种治疗方案下,患者在原位放置左心室辅助装置的 4 年中一直没有出现血栓栓塞并发症。这个病例说明,在特定情况下,使用 HeartMate 3 的患者可以长期不用华法林治疗。
Long-term discontinuation of warfarin in a patient with HeartMate 3 left ventricular assist device without thromboembolic events.
The gold standard therapy for end-stage heart failure is cardiac transplantation. However, in the face of a donor shortage, a mechanical assist device such as the left ventricular assist device HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) serves as bridging therapy to transplantation and/or destination therapy. Current guidelines recommend anticoagulation with a vitamin K antagonist in combination with low-dose aspirin. We herein report a challenging anticoagulation regimen in a patient with a HeartMate 3 in whom systemic anticoagulation with warfarin was not feasible for 4 years because of low compatibility and a rare X-factor deficiency. This is a rare hematological disorder, estimated to affect approximately 1 in every 500,000 to 1,000,000 people in the general population. The patient finally received a modified anticoagulation regimen involving the combination of rivaroxaban and clopidogrel without warfarin. Under this regimen, the patient remained free of thromboembolic complications for 4 years with in situ placement of the left ventricular assist device. This case illustrates that under specific circumstances, long-term absence of warfarin therapy is feasible in patients with a HeartMate 3.
期刊介绍:
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