Comparative study of novel oral anticoagulants and warfarin in the treatment of left ventricular thrombosis
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摘要: 目的 评价新型口服抗凝药物(NOAC)与华法林治疗左心室血栓(LVT)的有效性和安全性。方法 入选2018年—2021年心脏超声诊断LVT并接受6个月以上抗凝治疗，同时完成1次及以上心脏超声随访的患者311例，分为NOAC组(76例)及华法林组(235例)。抗凝治疗6个月后随访LVT直径及主要不良心血管事件(MACE)。结果 NOAC组的抗凝有效率明显高于华法林组(97.4% vs 90.2%，P=0.046)。经(3.2±1.1)年的随访，两组MACE无差异。结论 NOAC对LVT的抗凝有效率高于华法林，安全性与之相当。Abstract: Objective To evaluate the efficacy and safety of novel oral anticoagulants(NOAC) and warfarin in the treatment of left ventricular thrombosis(LVT).Methods A total of 311 patients diagnosed with LVT by echocardiography from 2018 to 2021, received anticoagulation therapy for more than 6 months and completed follow-up. They were divided into NOAC group(76 cases) and warfarin group(235 cases). LVT diameter and major adverse cardiovascular events(MACE) were detected 6 months after anticoagulant therapy.Results The anticoagulation effective rate of NOAC group was significantly higher than that of warfarin group(97.4% vs 90.2%, P=0.046). After(3.2±1.1) years of follow-up, there was no difference in MACE between the two groups.Conclusion NOAC has a higher anticoagulant efficacy than warfarin in LVT with the same safety as warfarin.
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表 1 LVT患者的临床特点
Table 1. General data
例(%), X±S 项目 华法林组 (235例) NOAC组 (76例) P 男性 213(90.6) 74(97.4) 0.06 年龄/岁 53.6±13.6 57.3±11.8 0.04 既往史 高血压病 82(34.9) 36(47.4) 0.05 糖尿病 60(25.5) 22(28.9) 0.56 高脂血症 10(4.3) 4(5.3) 0.71 房颤 21(8.9) 14(18.4) 0.02 慢性肾脏病 脑卒中 8(3.4) 4(5.3) 0.47 心肌梗死 151(64.3) 60(78.9) 0.02 PCI 135(57.4) 54(71.1) 0.04 CABG 18(7.7) 4(5.3) 0.48 心肌病 84(35.7) 14(18.4) 0.01 扩张型心肌病 44(18.7) 8(10.5) 0.10 肥厚型心肌病 8(3.4) 2(2.6) 0.74 其他心肌病 32(13.6) 2(2.6) 0.01 血肌酐/(μmol/L) 100.4±47.5 92.7±26.4 0.18 eGFR/(mL/min/1.72m2) 78.1±21.4 81.9±21.5 0.14 心力衰竭(LVEF < 50%) 169(71.9) 63(82.9) 0.04 LVEF/% 39.1±12.1 42.1±7.8 0.02 室壁瘤 54(23.0) 29(38.2) 0.01 左心室舒张末期内径/mm 56.5±8.2 57.7±8.07 0.24 左心室收缩末期内径/mm 43.1±10.5 42.6±10.0 0.71 左心房内径/mm 43.5±6.3 42.8±6.6 0.41 二尖瓣反流(中、重度) 12(5.1) 4(5.3) 0.96 eGFR：估算肾小球滤过率。 
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表 2 LVT患者合并用药情况
Table 2. Drug combination
例(%), X±S 项目 华法林组
(235例)NOAC组
(76例)P 华法林的剂量 2.62±0.81 TTR/% 66.3±21.5 阿司匹林 111(47.2) 39(51.3) 0.540 氯吡格雷 119(50.6) 52(68.4) 0.007 美托洛尔缓释片 205(87.2) 68(89.5) 0.610 ACEI/ARB/ARNI 187(79.6) 74(97.4) 0.001 TTR：INR在治疗范围内的时间。
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表 3 LVT的基线特点及抗凝治疗后变化
Table 3. Baseline characteristics and changes of LVT
例(%), X±S 项目 华法林组
(235例)NOAC组
(76例)P 原血栓长径/mm 24.2±10.3 27.9±11.0 0.007 原血栓短径/mm 13.6±4.8 15.0±6.6 0.047 原血栓面积/mm2 356±2.56 462±3.97 0.007 多枚血栓 12(5.1) 4(5.3) 0.960 抗凝有效 212(90.2) 74(97.4) 0.046 血栓缩小 60(25.5) 24(31.6) 0.370 血栓消失 152(64.7) 50(65.8) 0.860 抗凝无效 23(9.8) 2(2.6) 0.046 停药后血栓再发 50(21.3) 16(21.1) 0.970
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表 4 LVT患者抗凝治疗后不良事件
Table 4. Adverse events after anticoagulant therapy
例(%) 项目 华法林组
(235例)NOAC组
(76例)P 出血 22(9.4) 8(10.5) 0.770 严重出血 12(5.1) 6(7.9) 0.370 血栓栓塞 0 0 缺血性脑卒中 18(7.7) 1(1.3) 0.045 非致命性心肌梗死 8(3.4) 2(2.6) 0.740 全因死亡 10(4.3) 2(2.6) 0.520 MACE 40(15.8) 8(10.5) 0.170
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