Sandoval Julio, Santos Luis E, Córdova Julio, Pulido Tomás, Gutiérrez Gerardo, Bautista Edgar, Martinez Guerra Maria Luisa, Peña Héctor, Broberg Craig S
Cardiopulmonary Department, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico.
Congenit Heart Dis. 2012 May-Jun;7(3):268-76. doi: 10.1111/j.1747-0803.2012.00633.x. Epub 2012 Feb 23.
To determine the impact of anticoagulation on survival in Eisenmenger syndrome.
The use of anticoagulation for primary prevention of adverse events in patients with Eisenmenger syndrome has been proposed but not studied. Strong arguments have been made both for and against anticoagulation based on the known risk of hemoptysis and pulmonary vascular thrombosis.
Retrospective cohort study at a tertiary referral hospital.
One hundred forty-four patients with established Eisenmenger physiology all underwent initial laboratory, echocardiographic, and catheterization evaluation after initial referral. We retrospectively identified patients who were started on anticoagulation (AC) and compared them to patients who did not receive anticoagulation therapy (non-AC). Baseline variables were compared between groups, as well as between survivors and nonsurvivors. Analyses of prognostic factors and survival were done using Cox and Kaplan-Meier methods.
The primary outcome was death since time of baseline evaluation.
We identified 48 anticoagulated and 44 non-anticoagulated patients with Eisenmenger physiology (oxygen saturation 82 ± 9%, PaO(2) 48 ± 8 mm Hg, hemoglobin 18.6 ± 4 g/dL). More atrial septal defect patients were in the AC group, but there were no other baseline differences in clinical, functional, or hemodynamic data. After mean follow-up of 7 ± 5.4 years (range 1-31), 11 patients died in the AC and 10 died in the non-AC group. There was no survival difference between groups (log rank test = 1.78; P is not significant). For the entire cohort, mortality was significantly associated with New York Heart Association class 3-4 (hazard ratio = 4.2), evidence of right heart failure (hazard ratio = 13.6), and a mean corpuscular volume <80 fL (hazard ratio = 3.8). Use of anticoagulation did not impact survival. Bleeding complications occurred in seven (16%) of AC patients, including two fatalities.
Anticoagulation had no impact on long-term survival in this limited study. These data may be useful in considering future studies addressing this question.
确定抗凝治疗对艾森曼格综合征患者生存的影响。
已有人提出使用抗凝治疗来对艾森曼格综合征患者的不良事件进行一级预防，但尚未开展相关研究。基于咯血和肺血管血栓形成的已知风险，对于抗凝治疗存在支持和反对的有力观点。
在一家三级转诊医院开展的回顾性队列研究。
144例确诊为艾森曼格生理状态的患者在初次转诊后均接受了初步实验室、超声心动图及心导管检查评估。我们回顾性地确定开始接受抗凝治疗（AC）的患者，并将他们与未接受抗凝治疗（非AC）的患者进行比较。对两组之间以及生存者与非生存者之间的基线变量进行比较。使用Cox和Kaplan-Meier方法对抗预后因素和生存情况进行分析。
主要观察指标为自基线评估时间起的死亡情况。
我们确定了48例接受抗凝治疗和44例未接受抗凝治疗的艾森曼格生理状态患者（血氧饱和度82±9%，动脉血氧分压48±8mmHg，血红蛋白18.6±4g/dL）。AC组中房间隔缺损患者更多，但在临床、功能或血流动力学数据方面没有其他基线差异。在平均随访7±5.4年（范围1 - 31年）后，AC组有11例患者死亡，非AC组有10例患者死亡。两组之间无生存差异（对数秩检验=1.78；P无统计学意义）。对于整个队列，死亡率与纽约心脏协会3 - 4级显著相关（风险比=4.2）、存在右心衰竭证据（风险比=13.6）以及平均红细胞体积<80fL（风险比=3.8）。使用抗凝治疗对生存无影响。7例（16%）AC组患者发生出血并发症，包括2例死亡。
在这项有限的研究中，抗凝治疗对长期生存无影响。这些数据可能有助于考虑未来针对该问题的研究。
