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慢性心力衰竭(心衰)是大多数心血管疾病的最终归宿,其发病率呈逐年上升趋势。血栓形成和血栓栓塞事件是慢性心衰患者中较严重的并发症,在心衰病情发展和预后中起重要作用。心衰患者发生猝死可能是由于致命性血栓栓塞事件或冠脉内血栓形成,从而导致心肌梗死和室性心律失常所致。文献报道,心衰患者中血栓事件的临床发生率差异很大,为0.9～42.4事件/100人年,大型心衰临床试验中血栓事件为1.6～2.5事件/100人年。在左室射血分数(LVEF)≤40%的心肌梗死患者中,LVEF是卒中的独立危险因素。慢性心衰失代偿(NYHAⅢ级和Ⅳ级)是心内科常见的住院原因,而住院心衰患者是静脉血栓症(VTF)的高危人群。MEDENOX(prophylaxis in medical patients with enoxaparin)研究显示,在无抗凝治疗的住院心力衰竭患者(Ⅲ级和Ⅳ级)中VTE的发病率约为15%。在大型的心衰试验中,由于血栓栓塞和心肌梗死通常作为次于死亡率和再入院率的二级终点,可能导致这些血栓事件被低估。目前临床医生对心衰患者中血栓栓塞事件危险性升高还缺乏足够的认识。本文将近年来国内外有关心衰患者血栓栓塞相关因素的研究作较全面的论述。
Chronic heart failure (heart failure) is the ultimate fate of most cardiovascular diseases, the incidence rate showed an upward trend year by year. Thrombosis and thromboembolism are more serious complications in patients with chronic heart failure and play an important role in the development and prognosis of heart failure. Sudden death in patients with heart failure may be due to fatal thromboembolic events or coronary thrombosis, resulting in myocardial infarction and ventricular arrhythmias. Reported in the literature, the clinical incidence of thrombotic events in patients with heart failure vary widely, for the 0.9 ~ 42.4 events / 100 person-years, large heart failure clinical trials thrombosis events 1.6 to 2.5 events / 100 person-years. LVEF is an independent risk factor for stroke in patients with myocardial infarction with LVEF ≤40%. Chronic heart failure decompensation (NYHA class III and IV) is a common cause of hospitalization in cardiology and in-hospital HF patients are at high risk for venous thrombosis (VTF). The study of MEDENOX (prophylaxis in medical patients with enoxaparin) showed that the incidence of VTE in hospitalized patients with heart failure (Grade III and IV) without anticoagulation was about 15%. In large heart failure trials, thromboembolism and myocardial infarction, which are secondary endpoints of secondary mortality and readmission, may cause these thrombotic events to be underestimated. At present, clinicians lack sufficient knowledge about the dangerous increase of thromboembolism in patients with heart failure. This article in recent years at home and abroad about the factors related to thromboembolism in patients with heart failure to make a more comprehensive discussion.