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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中图分类号 R969.3;R973+.2 文献标志码A 文章编号 1001-0408（2025）20-2582-06

DOI 10.6039/j.issn.1001-0408.2025.20.17

Analysis of causes for initial antithrombotic therapy failureand the establishment of an antithrombotic pathway in arterial and venous thrombosis complicated with antiphospholipid syndrome

GUAN Yu，SHEN Zhu，ZHU Zhu（Dept. of Pharmacy，the Second Afiliated Hospital of Soochow University Jiangsu Suzhou 215004，China）

ABSTRACTOBJECTIVEToinvestigatethepotentialcausesof initialantithrombotictherapyfailureandestablishan antithromboticpathwayinarterialandvenous thrombosiscomplicatedwithantiphospholipidsyndrome（APS），aimingtooptimize clinical treatment.METHODSAretrospectiveanalysiswasconductedonthree patientswitharterialandvenous thrombosis accompaniedbyAPS；byintegrating clinicaldata，laboratorytests，imaging findings，andtreatmentprocesses，keyfactors contributingtoinitialantithrombotictherapyfailuresweresummarized.Theantithromboticpathwayinarterialandvenous thrombosis complicated with APS was established through areview of relevant literature.RESULTS&CONCLUSIONS The causesofinitialantithrombotictreatmentfailurein3patientsincludedselectingdirectoralanticoagulantsastefirstchoicefor antithrombotictherapy，using antiplateletdrugssuchasaspirinalone，andappying standardantithromboticregimenstopatients withrefractoryAPScomplicatedbyimmune diseaseslikesystemic lupuserythematosus.Thecopingstrategiesintheestablished antithromboticpathwayareasfollows：forvenous thromboembolicevents，secondarypreventionofthrombosisisthecoreand warfarinisthefirstchoice；forarterialthromboembolicevents，singleuseofantiplateletdrugshaslimitedeficacyandvitamin K antagonistsshouldbeusedincombinationforanticoagulation；forpatientswithcombinedvascularriskfactorsbutwithouthigh bleedingrisk，warfarincombinedwithantiplateletdrugsisprefered；forrefractoryAPS，asteppedtreatmentregimenshouldbe adopted，whichinvolvesfrstoptimizing warfarin，thenswitchingtothrapeutic-doselow-molecular-weightheparin，andswitching tofondaparinux if the treatment is ineffctiveorthe patient iscomplicatedby heparin-induced thrombocytopenia.

KEYWORDSarterialandvenous thrombosis；antiphospholipidsyndrome;antithrombosis；initial treatment failure；pathway

不明原因血栓是指在没有明确诱因（如手术、创伤、长期卧床等）的情况下发生的血栓事件。（剩余13657字）