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经皮左心耳封堵术治疗与抗凝治疗和心房颤动相关弥漫性肺泡出血患者。

Percutaneous Left Atrial Appendage Closure in a Patient with Diffuse Alveolar Hemorrhaging Associated with Anticoagulant Therapy and Atrial Fibrillation.

机构信息

Department of Respiratory, Kokura Memorial Hospital, Japan.

Department of Cardiovascular Medicine, Kokura Memorial Hospital, Japan.

出版信息

Intern Med. 2022 Jul 1;61(13):2045-2050. doi: 10.2169/internalmedicine.8551-21. Epub 2021 Nov 27.

DOI:10.2169/internalmedicine.8551-21
PMID:34840230
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9334249/
Abstract

Diffuse alveolar hemorrhaging (DAH) due to oral anticoagulation (OAC) is a life-threatening condition that leads to severe respiratory failure. There is a clinical dilemma in that OAC-induced DAH often forces the discontinuation of OAC therapy and the administration of high-dose corticosteroids, which increases the risk of stroke and cardiovascular events. We herein report the first case of OAC-induced DAH and atrial fibrillation (AF) in a patient who completely discontinued OAC therapy and high-dose corticosteroids after experiencing percutaneous left atrial appendage (LAA) occlusion. This case suggests that percutaneous LAA closure may aid in the management of OAC-induced DAH and AF.

摘要

弥漫性肺泡出血（DAH）是由口服抗凝剂（OAC）引起的，可导致严重的呼吸衰竭，是一种危及生命的病症。存在一个临床难题，即 OAC 引起的 DAH 常迫使停止 OAC 治疗并给予大剂量皮质类固醇，这会增加中风和心血管事件的风险。我们在此报告首例因接受经皮左心耳（LAA）封堵术而完全停止 OAC 治疗和大剂量皮质类固醇治疗的 OAC 诱导的 DAH 和心房颤动（AF）的患者。该病例表明，经皮 LAA 封堵术可能有助于 OAC 诱导的 DAH 和 AF 的治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/7ec8395f5894/1349-7235-61-2045-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/f41da9151fc0/1349-7235-61-2045-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/dd2bcbbd34cb/1349-7235-61-2045-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/e13d3d0c2c9b/1349-7235-61-2045-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/7ec8395f5894/1349-7235-61-2045-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/f41da9151fc0/1349-7235-61-2045-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/dd2bcbbd34cb/1349-7235-61-2045-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/e13d3d0c2c9b/1349-7235-61-2045-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d961/9334249/7ec8395f5894/1349-7235-61-2045-g004.jpg

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本文引用的文献

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Postprocedural Antithrombotic Therapy Following Left Atrial Appendage Occlusion: No Longer Adrift in Uncertainty?左心耳封堵术后的抗栓治疗：不再在不确定性中漂泊？
Circ Cardiovasc Interv. 2020 Jul;13(7):e009534. doi: 10.1161/CIRCINTERVENTIONS.120.009534. Epub 2020 Jul 17.
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Efficacy and Safety of Left Atrial Appendage Closure With WATCHMAN in Japanese Nonvalvular Atrial Fibrillation Patients　- Final 2-Year Follow-up Outcome Data From the SALUTE Trial.《WATCHMAN 在日本非瓣膜性心房颤动患者中的疗效和安全性 - SALUTE 试验的最终 2 年随访结果数据》。
Circ J. 2020 Jul 22;84(8):1237-1243. doi: 10.1253/circj.CJ-20-0196. Epub 2020 Jun 26.
3
Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation.
左心耳封堵术与直接口服抗凝剂在伴有心房颤动的高危患者中的比较。
J Am Coll Cardiol. 2020 Jun 30;75(25):3122-3135. doi: 10.1016/j.jacc.2020.04.067.
4
A rare case of Diffuse Alveolar Hemorrhage (DAH) due to warfarin toxicity.一例罕见的因华法林中毒导致的弥漫性肺泡出血（DAH）病例。
Rom J Intern Med. 2020 Mar 1;58(1):35-39. doi: 10.2478/rjim-2019-0023.
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Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature.华法林所致弥漫性肺泡出血：病例报告及文献复习
Lung India. 2019 Nov-Dec;36(6):534-539. doi: 10.4103/lungindia.lungindia_8_19.
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Immune diffuse alveolar hemorrhage: Clinical presentation and outcome.免疫性弥漫性肺泡出血：临床表现与预后
Respir Med. 2017 Aug;129:59-62. doi: 10.1016/j.rmed.2017.06.003. Epub 2017 Jun 3.
7
Diffuse Alveolar Hemorrhage Associated with Edoxaban Therapy.与依度沙班治疗相关的弥漫性肺泡出血
Case Rep Crit Care. 2016;2016:7938062. doi: 10.1155/2016/7938062. Epub 2016 Oct 31.
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Clinical Features and Outcomes of Diffuse Alveolar Hemorrhage During Antithrombotic Therapy: A Retrospective Cohort Study.抗栓治疗期间弥漫性肺泡出血的临床特征及结局：一项回顾性队列研究
Lung. 2016 Jun;194(3):475-81. doi: 10.1007/s00408-016-9873-4. Epub 2016 Apr 4.
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A Bloody Mess: An Unusual Case of Diffuse Alveolar Hemorrhage Because of Warfarin Overdose.一片血腥混乱：一例因华法林过量导致的弥漫性肺泡出血罕见病例。
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