Bounhoure J P, Galinier M, Pathak A
Service de cardiologie, Hôpital de Bangueil, Toulouse.
Arch Mal Coeur Vaiss. 2000 Feb;93 Spec No 2:29-32.
In cardiac failure, should conventional therapy be associated systematically with anticoagulant or antiplatelet therapy? Embolic complications are uncommon (1 to 2.5% per year) and the benefit/risk ratio seems to be marginal. The absence of prospective randomised controlled trials makes it impossible to give a definitive reply to this question. The indications of oral anticoagulants are based on experience, good sense, the recognition of known embolic risk factors: severe cardiac failure, atrial fibrillation, EF < 0.30 and low VO2 max, mitral valve disease or prosthetic valve, detection of intracavitary thrombus or spontaneous contrast on transoesophageal echocardiography. Aspirin does not seem to be mandatory even if it reduces the thromboembolic risk non-significantly. In this elderly population with a high co-morbidity, the risks of haemorrhage cannot be ignored, and, if oral anticoagulants are prescribed, biological surveillance must be intensive.
在心力衰竭中，传统治疗是否应常规联合抗凝或抗血小板治疗？栓塞并发症并不常见（每年1%至2.5%），且获益/风险比似乎微不足道。由于缺乏前瞻性随机对照试验，无法对这个问题给出明确答复。口服抗凝药的适应证基于经验、合理判断以及对已知栓塞风险因素的识别：严重心力衰竭、心房颤动、射血分数<0.30和最大摄氧量低、二尖瓣疾病或人工瓣膜、经食管超声心动图检测到心腔内血栓或自发显影。阿司匹林似乎并非必需，即便它能非显著降低血栓栓塞风险。在这个合并症高发的老年人群中，出血风险不容忽视，并且，如果开具口服抗凝药，必须进行密切的生物学监测。
