Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
Department of Gastroenterology and Hepatology, University of Kentucky College of Medicine, Lexington, KY, USA.
Am J Cardiovasc Drugs. 2022 Jan;22(1):55-67. doi: 10.1007/s40256-021-00478-6. Epub 2021 May 29.
Liver cirrhosis (LC) is becoming increasingly common among patients presenting with acute coronary syndromes (ACS) and is associated with significant cardiovascular morbidity and mortality. Management of such patients is complicated by LC related complications. Literature is scarce on the safety of antithrombotic regimens and invasive strategies for ACS in patients with LC, especially those undergoing liver transplant evaluation. Recently there has been evidence that cirrhosis is an independent risk factor for adverse outcomes in ACS. As patients with LC are generally excluded from large randomized trials, definitive guidelines for the management of ACS in this particular cohort are lacking. Many antithrombotic drugs require either hepatic activation or clearance; hence, an accurate assessment of hepatic function is required prior to initiation and dose adjustment. Despite a demonstrated survival benefit of optimal medical therapy and invasive revascularization techniques in LC patients with ACS, both strategies are currently underutilized in this population. This review aims to present currently available data and provide a practical, clinically oriented approach for the management of ACS in LC. Randomized clinical trials in LC patients with ACS are the need of the hour to further refine their management for favorable outcomes.
肝硬化（LC）在出现急性冠状动脉综合征（ACS）的患者中越来越常见，与显著的心血管发病率和死亡率相关。LC 相关并发症使此类患者的管理变得复杂。关于 LC 患者的抗血栓治疗方案和侵入性策略的安全性，尤其是那些正在接受肝移植评估的患者，文献资料稀缺。最近有证据表明，肝硬化是 ACS 不良结局的独立危险因素。由于 LC 患者通常被排除在大型随机试验之外，因此针对该特定患者群体的 ACS 管理的明确指南缺乏。许多抗血栓药物需要肝脏激活或清除；因此，在开始治疗和调整剂量之前，需要对肝功能进行准确评估。尽管 LC 合并 ACS 患者接受最佳药物治疗和侵入性血运重建技术有生存获益的证据，但这两种策略在该人群中的应用均不足。本综述旨在介绍目前可用的数据，并为 LC 合并 ACS 的管理提供实用的临床方法。LC 合并 ACS 患者的随机临床试验是当前的迫切需求，以便进一步改善其治疗效果。
