اثر داروهای ضد پلاکتی بر روی حوادث ترومبوآمبولی در بیماران با سوراخ بین دهلیزی بسته شده با مسدود کننده
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دانشگاه علوم پزشکی تبریز، دانشکده پزشکی
Tabriz University of Medical Sciences, Faculty of Medicine
Tabriz University of Medical Sciences, Faculty of Medicine
Abstract
نقص دیواره بین دهلیزی یا ASD یکی از شایعترین نقایص مادرزادی قلبی است که در آن یک سوراخ در دیواره بین دو دهلیز قلب وجود دارد. روش ترانس کاتتر به دلیل کمتهاجمی بودن و دوره نقاهت کوتاهتر، در سالهای اخیر به عنوان یک گزینه درمانی محبوب برای بیماران مبتلا به ASD مورد استفاده قرار گرفته است. داروهای ضد پلاکتی (مانند آسپرین و کلوپیدوگرل) با کاهش تجمع پلاکتی و ویسکوزیته خون، خطر تشکیل لخته و حوادث ترومبوآمبولی را به ویژه در بیماران پرخطر کاهش میدهند. هرچند این داروها ممکن است عوارضی مانند خونریزی ایجاد کنند و نیاز به ارزیابی دقیق نسبت سود به خطر توسط پزشکان دارند. در مورد مدت زمان بهینه مصرف همزمان این داروها پس از اقدامات پزشکی (مانند بستن ASD)، اختلاف نظر وجود دارد و دورههای یک ماهه، سه ماهه یا شش ماهه در منابع مختلف پیشنهاد شده است. هدف از این مطالعه با رویکرد گذشتهنگر، مقایسه اثربخشی دو رژیم یک ماهه و سه ماهه مصرف آسپرین و پلاویکس در پیشگیری از عوارض ترومبوآمبولیک است.
مواد و روشها: در این مطالعه گذشته نگر که با مراجعه به پرونده بیماران در عرض ١٠ سال اخیر از سال ١٣٩٢ تا ١٤٠٢ به تمام بیمارانی که سوراخ ASD آنها به روش ترانس کاتتر بسته شده است به دو گروه با مصرف داروی یک ماهه و سه ماهه تقسیم شدند مشخصات بالینی و نتایج پاراکلینیک در بیماران بررسی گردید و حوادث ترومبوآمبولیک در دو گروه مقایسه شد.
یافتهها: روش ترانس کاتتر برای بستن نقص دیواره بین دهلیزی (ASD) یک روش ایمن و مؤثر است که در گروه سنی بزرگسالان شایعتر از کودکان بود. شایعترین علامت بالینی در بیماران مورد بررسی SMMR بود و اکثر بیماران دارای ECG نرمال بودند. درمان ضد پلاکتی با آسپرین و پلاویکس در پیشگیری از حوادث ترومبوآمبولیک مؤثر بود و تفاوت معنیداری بین مدت زمان درمان یک ماهه و سه ماهه وجود نداشت.
Atrial septal defect (ASD) is one of the most common congenital heart defects in which there is a hole in the wall between the two atria of the heart. The transcatheter approach has been used as a popular treatment option for patients with ASD in recent years due to its minimal invasiveness and shorter recovery period. Given the importance of clot formation during or after this procedure, the use of antiplatelet drugs, including aspirin and Plavix, is recommended. In this retrospective study, the antiplatelet effect of the above drugs in the studied patients was investigated and compared in two one-month and three-month periods. Materials and Methods: In this retrospective study, which referred to the patient records within the last 10 years from 2013 to 2014, all patients whose ASD holes were closed by the transcatheter method were divided into two groups with one-month and three-month drug use. Clinical characteristics and paraclinical results of the patients were examined and thromboembolic events were compared in the groups. Results: The Transcatheter method for closing ASD is a safe and effective method that was more common in the adult age group than in children. The most common clinical symptom in the patients studied was SMMR and most patients had normal ECG. Antiplatelet therapy with aspirin and Plavix was effective in preventing thromboembolic events and there was no significant difference between the duration of one-month and three-month treatment.
Atrial septal defect (ASD) is one of the most common congenital heart defects in which there is a hole in the wall between the two atria of the heart. The transcatheter approach has been used as a popular treatment option for patients with ASD in recent years due to its minimal invasiveness and shorter recovery period. Given the importance of clot formation during or after this procedure, the use of antiplatelet drugs, including aspirin and Plavix, is recommended. In this retrospective study, the antiplatelet effect of the above drugs in the studied patients was investigated and compared in two one-month and three-month periods. Materials and Methods: In this retrospective study, which referred to the patient records within the last 10 years from 2013 to 2014, all patients whose ASD holes were closed by the transcatheter method were divided into two groups with one-month and three-month drug use. Clinical characteristics and paraclinical results of the patients were examined and thromboembolic events were compared in the groups. Results: The Transcatheter method for closing ASD is a safe and effective method that was more common in the adult age group than in children. The most common clinical symptom in the patients studied was SMMR and most patients had normal ECG. Antiplatelet therapy with aspirin and Plavix was effective in preventing thromboembolic events and there was no significant difference between the duration of one-month and three-month treatment.