随着先天性心脏病治疗的改善,更多的儿科患者在儿童时期接受姑息或矫正干预,从而成为患有先天性心脏病(ACHD)的成年人。总的来说,ACHD人群发生心律失常和卒中的风险较高.他们矫正心脏的结构和功能异常表明,除了既定的中风危险因素外,例如以前的中风或年龄较大,需要考虑其他卒中风险因素,以确定ACHD患者的风险并确定口服抗凝(OAC)适应症.在结构正常的心脏中,与房颤(AF)或肺栓塞患者的维生素K拮抗剂(VKA)相比,非维生素K口服抗凝剂(NOAC)可提供至少同等的中风预防,并具有更好的安全性。目前的指南推荐NOAC用于简单病变和OAC适应症的ACHD患者,尽管在患有中度或复杂先天性心脏病的ACHD患者中,例如在心房开关手术(Senning或Mustard手术)后发生大动脉转位(TGA)的患者中,对其安全性的确定性较低,Fontan循环或先天性矫正的大动脉转位(ccTGA)。这篇综述总结了ACHD患者卒中风险的可用证据,以及使用抗凝药和介入疗法来降低该风险。
With improvements in treatment of congenital heart disease more paediatric patients are surviving with palliative or corrective interventions during childhood, thus becoming adults with congenital heart disease (ACHD). Overall, the ACHD population is at a higher risk of arrhythmias and stroke. The abnormal structure and function of their corrected hearts suggests that in addition to established stroke risk factors, such as prior stroke or older age, additional stroke risk factors need to be considered to determine the risk and establish the indication for oral anticoagulation (OAC) in ACHD patients. In structurally normal hearts non-vitamin-K oral anticoagulants (NOACs) offer at least equal stroke prevention with a better safety profile compared to vitamin K antagonists (VKA) in patients with atrial fibrillation (AF) or pulmonary embolism. Current guidelines recommend NOACs in ACHD patients with simple lesions and indication for OAC, while there is less certainty about their safety in ACHD patients with moderate or complex congenital heart disease such as patients with transposition of the great arteries (TGA) after atrial switch operation (Senning or Mustard operation), Fontan circulation or congenital corrected transposition of the great arteries (ccTGA). This
review summarises the available evidence characterising stroke risk in patients with ACHD and the use of anticoagulants and interventional therapies to reduce that risk.