动静脉血栓伴抗磷脂综合征初始抗栓治疗失败原因分析与抗栓路径建立-中国药房

动静脉血栓伴抗磷脂综合征初始抗栓治疗失败原因分析与抗栓路径建立

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篇名：	动静脉血栓伴抗磷脂综合征初始抗栓治疗失败原因分析与抗栓路径建立
TITLE：	Analysis of causes for initial antithrombotic therapy failure and the establishment of an antithrombotic pathway in arterial and venous thrombosis complicated with antiphospholipid syndrome
摘要：	目的探讨动静脉血栓伴抗磷脂综合征（APS）患者初始抗栓治疗失败的可能原因，并建立抗栓路径，为优化临床治疗提供参考。方法回顾性分析3例动静脉血栓伴APS患者的临床资料，结合其实验室检查、影像学结果及治疗过程，总结初始抗栓治疗失败的关键因素；通过文献回顾，建立动静脉血栓伴APS的抗栓路径。结果与结论3例患者初始抗栓治疗失败的原因包括：将直接口服抗凝药作为抗栓首选药物、阿司匹林等抗血小板药物单用、将标准抗栓方案用于合并系统性红斑狼疮等免疫性疾病的难治性APS患者。所建抗栓路径的应对策略包括：对于静脉血栓栓塞事件，以血栓二级预防为核心，以华法林为首选；对于动脉血栓栓塞事件，单用抗血小板药物效果有限，应联合维生素K拮抗剂抗凝；对于合并血管危险因素但无高出血风险者，倾向于华法林联合抗血小板药物；对于难治性APS，应采用“优化华法林方案-使用治疗剂量的低分子肝素-无效或合并肝素诱导的血小板减少症时换用磺达肝癸钠”的阶梯式治疗方案。
ABSTRACT：	OBJECTIVE To investigate the potential causes of initial antithrombotic therapy failure and establish an antithrombotic pathway in arterial and venous thrombosis complicated with antiphospholipid syndrome （APS）， aiming to optimize clinical treatment. METHODS A retrospective analysis was conducted on three patients with arterial and venous thrombosis accompanied by APS； by integrating clinical data， laboratory tests， imaging findings， and treatment processes， key factors contributing to initial antithrombotic therapy failures were summarized. The antithrombotic pathway in arterial and venous thrombosis complicated with APS was established through a review of relevant literature. RESULTS & CONCLUSIONS The causes of initial antithrombotic treatment failure in 3 patients included selecting direct oral anticoagulants as the first choice for antithrombotic therapy， using antiplatelet drugs such as aspirin alone， and applying standard antithrombotic regimens to patients with refractory APS complicated by immune diseases like systemic lupus erythematosus. The coping strategies in the established antithrombotic pathway are as follows： for venous thromboembolic events， secondary prevention of thrombosis is the core and warfarin is the first choice； for arterial thromboembolic events， single use of antiplatelet drugs has limited efficacy and vitamin K antagonists should be used in combination for anticoagulation； for patients with combined vascular risk factors but without high bleeding risk， warfarin combined with antiplatelet drugs is preferred； for refractory APS， a stepped treatment regimen should be adopted， which involves first optimizing warfarin， then switching to therapeutic-dose low-molecular-weight heparin， and switching to fondaparinux if the treatment is ineffective or the patient is complicated by heparin-induced thrombocytopenia.
期刊：	2025年第36卷第20期
作者：	管玉；沈珠；朱珠
AUTHORS：	GUAN Yu，SHEN Zhu，ZHU Zhu
关键字：	动静脉血栓；抗磷脂综合征；抗栓；初始治疗失败；路径
KEYWORDS：	arterial and venous thrombosis； antiphospholipid syndrome； antithrombosis； initial treatment failure； pathway
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