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心脏淀粉样变性伴发心房颤动的抗凝治疗:一篇叙述性综述

Anticoagulation in Atrial Fibrillation Associated With Cardiac Amyloidosis: A Narrative Review.

作者信息

Monga Tejbir S, Ekong Mfonido, Patrick Kayé, Bommana Boyena Tulasi Geethika, Ravanam Aneela Satya, Vargas Santiago, Mavus Nur Bengisu, Lakshmi A P, Singh Kanwaraj, Vegesna Ramya Reshma, Abbas Kiran

机构信息

Internal Medicine, Spartan Health Sciences University, Vieux Fort, LCA.

Internal Medicine, St. George's University School of Medicine, True Blue, GRD.

出版信息

Cureus. 2024 Jun 3;16(6):e61557. doi: 10.7759/cureus.61557. eCollection 2024 Jun.

Abstract

Cardiac amyloidosis (CA) involves the abnormal deposition and accumulation of amyloid proteins in the heart muscle. A hallmark of disease progression is declining heart function, which can lead to structural irregularities, arrhythmias, and ultimately heart failure. Atrial fibrillation (AF) is the most common arrhythmia that presents in CA patients, and this arrhythmia is significant because it can moderately increase the risk of patients developing intracardiac thrombi, thereby putting them at risk for thromboembolic events. The management of this complication entails the use of anticoagulants like vitamin K antagonists and direct oral anticoagulants to reduce the risk of thrombus formation. This article seeks to review AF in CA and the use of anticoagulation therapy for the management and reduction of thromboembolic risk. The major conclusions of this review are centered around the need for safe administration of anticoagulant therapy to CA patients, regardless of their CHA2DS2-VASc risk score. This review highlights the importance of taking a multidisciplinary or collaborative approach to CA treatment to ensure that all aspects of this multifaceted disease can be properly managed while minimizing adverse events like bleeding risk and drug-drug interactions.

摘要

心脏淀粉样变性(CA)涉及淀粉样蛋白在心肌中的异常沉积和积聚。疾病进展的一个标志是心脏功能下降,这可能导致结构异常、心律失常,并最终导致心力衰竭。心房颤动(AF)是CA患者中最常见的心律失常,这种心律失常很重要,因为它会适度增加患者发生心内血栓的风险,从而使他们面临血栓栓塞事件的风险。处理这种并发症需要使用维生素K拮抗剂和直接口服抗凝剂等抗凝剂来降低血栓形成的风险。本文旨在综述CA中的AF以及使用抗凝治疗来管理和降低血栓栓塞风险。本综述的主要结论集中在需要对CA患者安全给予抗凝治疗,无论其CHA2DS2-VASc风险评分如何。本综述强调了采用多学科或协作方法治疗CA的重要性,以确保这种多方面疾病的所有方面都能得到妥善管理,同时将出血风险和药物相互作用等不良事件降至最低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/385e/11221388/eb2056902244/cureus-0016-00000061557-i01.jpg

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