Prati P L, Piazza V
Divisione Cardiologia I, Ospedale S Camillo, Roma.
Cardiologia. 1994 Dec;39(12 Suppl 1):353-6.
Patients with atrial fibrillation are at risk for peripheral embolism. Congestive heart failure, a history of hypertension, previous arterial embolism or myocardial infarction are related to an increased risk for thromboembolism. Left ventricular enlargement and dysfunction, focal akinesia, protruding and mobile thrombi, spontaneous echo contrast are echocardiographic predictors of thromboembolism in patients with atrial fibrillation. Clinical trials have shown that antithrombotic therapy can reduce the rate of embolic events. In patients with heart failure the efficacy of antithrombotic therapy has not been tested in randomized, prospective trials. However in these patients oral anticoagulants are recommendable in the following conditions: atrial fibrillation; rheumatic mitral valve disease; previous thromboembolism; left ventricular enlargement and dysfunction; mobile and/or protruding thrombi; spontaneous echo contrast. The target INR in treated patients should be maintained within a range of 2 to 3 times the control. A more intense range of intensity of anticoagulation is indicated for patients with mechanical prosthetic valves or with relapsing thromboembolism. Current estimates of the effects of aspirin vary too much to allow any conclusions.
心房颤动患者存在外周栓塞风险。充血性心力衰竭、高血压病史、既往动脉栓塞或心肌梗死与血栓栓塞风险增加有关。左心室扩大和功能障碍、节段性运动减弱、突出且可移动的血栓、自发显影对比是心房颤动患者血栓栓塞的超声心动图预测指标。临床试验表明，抗栓治疗可降低栓塞事件发生率。在心力衰竭患者中，抗栓治疗的疗效尚未在随机前瞻性试验中得到验证。然而，在这些患者中，以下情况下推荐口服抗凝药：心房颤动；风湿性二尖瓣疾病；既往血栓栓塞；左心室扩大和功能障碍；可移动和/或突出的血栓；自发显影对比。接受治疗患者的目标国际标准化比值（INR）应维持在对照值的2至3倍范围内。对于植入机械瓣膜或复发性血栓栓塞患者，需要更强化的抗凝强度。目前关于阿司匹林效果的评估差异太大，无法得出任何结论。
