Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature

ESC Heart Failure

John Parissis¹  Ovidiu Chioncel²  Yuri Lopatin³  Magdy Abdelhamid⁴  Marco Metra⁵  Marianna Adamo⁶  Alexander Lyon⁷  Andrew P. Ambrosy⁸  Tuvia Ben Gal⁹  Stefan D. Anker^1,10  Oscar Miro^1,11  Razvan I. Radu^1,12  Oliviana Geavlete^1,12  Elena‐Laura Antohi^1,12  Sean P. Collins^1,13 

[1] Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy;Vanderbilt University Medical Centre Nashville TN USA;Cardiology Centre Volgograd Medical University Volgograd Russian Federation;Cardiology Department, Kasr Alainy School of Medicine Cairo University Cairo Egypt;Cardiology, Cardiothoracic Department, Civil Hospitals;Cardiothoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy;Cardio‐Oncology Service Royal Brompton Hospital and Imperial College London London UK;Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA USA;Department of Cardiology, Rabin Medical Center (Beilinson Campus), Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel;Department of Emergency Medicine;Emergency Department, Hospital Clínic de Barcelona University of Barcelona Barcelona Spain;ICCU Department Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’ Bucharest Romania;Second Department of Cardiology, Attikon University Hospital National and Kapodistrian University of Athens Athens Greece;

关键词: Cardiogenic shock;    Antithrombotic therapy;    Antiplatelet therapy;    Anticoagulation therapy;   

DOI  :  10.1002/ehf2.13643

来源: DOAJ

【 摘 要 】

Abstract Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non‐acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short‐term or long‐term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi‐organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis.

【 授权许可】

Unknown