1. Clinical application of blood coagulation projects in heart and cerebrovascular diseases
In Worldwide, the number of people suffering from cardiovascular and cerebrovascular diseases is large, and it is showing an increasing trend year by year. In clinical practice, common patients have a short onset time and are accompanied by cerebral hemorrhage, which adversely affects the prognosis and threatens the life safety of patients.
There are many diseases of cardiovascular and cerebrovascular diseases, and their influencing factors are also very complex. With the continuous deepening of clinical research on coagulation, it is found that in cardiovascular and cerebrovascular diseases, coagulation factors can also be used as risk factors for this disease. Clinical studies have shown that both the extrinsic and intrinsic coagulation pathways of such patients will have an impact on the diagnosis, evaluation and prognosis of such diseases. Therefore, a comprehensive assessment of the coagulation risk of patients is of great importance for patients with cardiovascular and cerebrovascular diseases. significance.
2. Why should patients with heart and cerebrovascular diseases pay attention to coagulation indicators
Cardiovascular and cerebrovascular diseases are diseases that seriously endanger human health and life, with high mortality and high disability rates.
Through the detection of coagulation function in patients with cardiovascular and cerebrovascular diseases, it is possible to assess whether the patient has hemorrhage and the risk of venous thrombosis; in the process of subsequent anticoagulation therapy, the anticoagulation effect can also be assessed and clinical medication can be guided to avoid bleeding.
1). Stroke patients
Cardioembolic stroke is an ischemic stroke caused by cardiogenic emboli shedding and embolizing corresponding cerebral arteries, accounting for 14% to 30% of all ischemic strokes. Among them, atrial fibrillation-related stroke accounts for more than 79% of all cardioembolic strokes, and cardioembolic strokes are more serious, and should be identified early and actively intervened. To evaluate the thrombosis risk and anticoagulation treatment of patients, and anticoagulation treatment clinical needs to use coagulation indicators to evaluate the anticoagulation effect and precise anticoagulation medication to prevent bleeding.
The greatest risk in patients with atrial fibrillation is arterial thrombosis, especially cerebral embolism. Anticoagulation recommendations for cerebral infarction secondary to atrial fibrillation:
1. Routine immediate use of anticoagulants is not recommended for patients with acute cerebral infarction.
2. In patients treated with thrombolysis, it is generally not recommended to use anticoagulants within 24 hours.
3. If there are no contraindications such as bleeding tendency, severe liver and kidney disease, blood pressure >180/100mmHg, etc., the following conditions can be considered selective use of anticoagulants:
(1) Patients with cardiac infarction (such as artificial valve, atrial fibrillation, myocardial infarction with mural thrombus, left atrial thrombosis, etc.) are prone to recurrent stroke.
(2) Patients with ischemic stroke accompanied by protein C deficiency, protein S deficiency, active protein C resistance and other thromboprone patients; patients with symptomatic extracranial dissecting aneurysm; patients with intracranial and intracranial artery stenosis.
(3) Bedridden patients with cerebral infarction can use low-dose heparin or corresponding dose of LMWH to prevent deep vein thrombosis and pulmonary embolism.
2). The value of coagulation index monitoring when anticoagulant drugs are used
• PT: The laboratory's INR performance is good and can be used to guide the dose adjustment of warfarin; assess the bleeding risk of rivaroxaban and edoxaban.
• APTT: Can be used to assess the efficacy and safety of (moderate doses) unfractionated heparin and to qualitatively assess the bleeding risk of dabigatran.
• TT: Sensitive to dabigatran, used to verify residual dabigatran in blood.
• D-Dimer/FDP: It can be used to evaluate the therapeutic effect of anticoagulant drugs such as warfarin and heparin; and to evaluate the therapeutic effect of thrombolytic drugs such as urokinase, streptokinase, and alteplase.
• AT-III: It can be used to guide the medication effects of heparin, low molecular weight heparin, and fondaparinux, and to indicate whether it is necessary to change anticoagulants in clinical practice.
3). Anticoagulation before and after cardioversion of atrial fibrillation
There is a risk of thromboembolism during cardioversion of atrial fibrillation, and appropriate anticoagulation therapy can reduce the risk of thromboembolism. For hemodynamically unstable patients with atrial fibrillation requiring urgent cardioversion, the initiation of anticoagulation should not delay cardioversion. If there is no contraindication, heparin or low molecular weight heparin or NOAC should be used as soon as possible, and cardioversion should be performed at the same time
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