{"id":147102,"date":"2023-12-04T06:30:13","date_gmt":"2023-12-04T06:30:13","guid":{"rendered":"https:\/\/labinsights.com\/acf_article\/roi-loan-dong-mau-trong-suy-tim-sinh-ly-benh-va-quan-ly-lam-sang\/"},"modified":"2026-02-24T05:36:47","modified_gmt":"2026-02-24T05:36:47","slug":"coagulation-disorders-in-heart-failure-pathophysiology-and-clinical-management","status":"publish","type":"acf_article","link":"https:\/\/labinsights.com\/vi\/disease-area\/cardiology\/coagulation-disorders-in-heart-failure-pathophysiology-and-clinical-management\/","title":{"rendered":"R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u trong suy tim: sinh l\u00fd b\u1ec7nh v\u00e0 qu\u1ea3n l\u00fd l\u00e2m s\u00e0ng"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u trong suy tim<\/h2>\n

Suy tim (Heart Failure, HF) l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng g\u00e2y ra b\u1edfi r\u1ed1i lo\u1ea1n c\u1ea5u tr\u00fac ho\u1eb7c ch\u1ee9c n\u0103ng c\u1ee7a tim d\u1eabn \u0111\u1ebfn \u00e1p l\u01b0\u0323c co bo\u0301p cu\u0309a tim t\u0103ng v\u00e0 \/ ho\u1eb7c cung l\u01b0\u1ee3ng tim kh\u00f4ng \u0111\u1ee7 trong qu\u00e1 tr\u00ecnh t\u1eadp th\u1ec3 d\u1ee5c ho\u1eb7c ngh\u1ec9 ng\u01a1i. T\u00ecnh tr\u1ea1ng n\u00e0y d\u00e2\u0303n \u0111\u00ea\u0301n gia t\u0103ng nguy c\u01a1 bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch. Vi\u1ec7c n\u00e2ng cao nh\u1eadn th\u1ee9c v\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y c\u1ee7a c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng, c\u0169ng nh\u01b0 c\u00e1c nga\u0300y ca\u0300ng co\u0301 nhi\u00ea\u0300u nghi\u00ean c\u01b0\u0301u va\u0300 h\u01b0\u01a1\u0301ng d\u00e2\u0303n cu\u0323 th\u00ea\u0309 r\u00f5 r\u00e0ng h\u01a1n trong qu\u1ea3n l\u00fd b\u00ea\u0323nh, c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u t\u1ed1t h\u01a1n cho b\u1ec7nh nh\u00e2n HF.<\/p>\n

Sinh b\u1ec7nh h\u1ecdc c\u1ee7a r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u trong HF<\/h2>\n

Suy tim \u0111\u01b0\u1ee3c chia th\u00e0nh 3 nh\u00f3m nho\u0309, d\u1ef1a tr\u00ean ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i (LVEF): HF co\u0301 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m (HFrEF); HF co\u0301 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m nh\u1eb9 (HFmrEF); v\u00e0 suy tim ba\u0309o t\u00f4\u0300n ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u (HFpEF). M\u1ed7i ph\u00e2n nh\u00f3m c\u00f3 nh\u01b0\u0303ng \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3 v\u00e0 c\u00e1c b\u1ec7nh ke\u0300m theo ph\u1ed5 bi\u1ebfn, bao g\u1ed3m nguy c\u01a1 bi\u1ebfn ch\u1ee9ng huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch [2].<\/p>\n

\"nh\u01b0\u0303ng<\/p>\n

Suy tim v\u00e0 huy\u1ebft kh\u1ed1i th\u01b0\u1eddng c\u00f3 li\u00ean quan v\u01a1\u0301i nhau vi\u0300 m\u1ed9t s\u1ed1 l\u00fd do sau. \u0110\u00e2\u0300u ti\u00ean, b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, m\u00f4\u0323t nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y HF, d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh c\u00e1c huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch th\u00f4ng qua qua\u0301 tri\u0300nh ho\u1ea1t h\u00f3a v\u00e0 k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u. Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (VTE) c\u0169ng ph\u1ed5 bi\u1ebfn trong HF, l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 do t\u1eafc m\u1ea1ch v\u00e0 \u0111\u1ed9t t\u1eed. Nguy c\u01a1 huy\u1ebft kh\u1ed1i v\u00e0 \u0111\u1ed9t qu\u1ef5 \u0111\u1eb7c bi\u1ec7t t\u0103ng cao khi b\u1ec7nh nh\u00e2n HF c\u00f3 c\u00e1c b\u1ec7nh kh\u00e1c \u0111i k\u00e8m nh\u01b0 rung nh\u0129 (Atrial Fibrillation, AF). H\u01a1n m\u1ed9t n\u1eeda s\u1ed1<\/p>\n

\"b\u1ec7nh<\/p>\n

S\u1ef1 b\u1ea5t th\u01b0\u1eddng trong t\u1ea5t c\u1ea3 ba y\u00ea\u0301u t\u00f4\u0301 c\u1ee7a tam ch\u01b0\u0301ng Virchow – r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i ma\u0323c ma\u0323ch, \u1ee9 tr\u00ea\u0323 tu\u00e2\u0300n hoa\u0300n v\u00e0 t\u0103ng \u0111\u00f4ng – l\u00e0m t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i trong HF. Tuy nhi\u00ean, nh\u01b0\u0303ng nguy\u00ean nh\u00e2n g\u00e2y ra huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch la\u0300 kh\u00e1c nhau. C\u00e1c c\u1ee5c ma\u0301u \u0111\u00f4ng \u01a1\u0309 \u0111\u00f4\u0323ng ma\u0323ch r\u1ea5t gi\u00e0u ti\u1ec3u c\u1ea7u v\u00e0 h\u00ecnh th\u00e0nh d\u01b0\u1edbi \u01b0\u0301ng su\u00e2\u0301t c\u1eaft cao, trong khi c\u00e1c c\u1ee5c m\u00e1u \u0111\u00f4ng \u1edf t\u0129nh m\u1ea1ch gi\u00e0u fibrin v\u00e0 h\u00ecnh th\u00e0nh trong m\u00f4i tr\u01b0\u1eddng \u01b0\u0301ng su\u00e2\u0301t c\u1eaft th\u1ea5p h\u01a1n. B\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n g\u00e2y HF hay c\u00e1c b\u1ec7nh \u0111i k\u00e8m la\u0300 gi\u0300, s\u1ef1 r\u00f4\u0301i loa\u0323n ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u v\u00e0 a\u0309nh h\u01b0\u01a1\u0309ng c\u1ee7a n\u00f3 t\u1edbi c\u00e1c con \u0111\u01b0\u1eddng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1ee3c nh\u00e2\u0323n th\u1ea5y trong qua\u0301 tri\u0300nh ki\u0301ch thi\u0301ch ta\u0323o huy\u1ebft kh\u1ed1i hi\u0300nh do HF [2].<\/p>\n

M\u1eb7c d\u00f9 c\u00e1c bi\u1ebfn ch\u1ee9ng do huy\u1ebft kh\u1ed1i th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 m\u1ed9t trong nh\u01b0\u0303ng v\u1ea5n \u0111\u1ec1 c\u00e2\u0300n quan t\u00e2m ha\u0300ng \u0111\u00e2\u0300u \u1edf b\u1ec7nh nh\u00e2n suy tim, nh\u01b0ng t\u00ecnh tr\u1ea1ng n\u00e0y c\u00f3 li\u00ean quan \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u [3]. V\u00ed d\u1ee5: t\u1ef7 l\u1ec7 \u0111\u1ed9t qu\u1ef5 t\u0103ng cao h\u01a1n trong th\u00e1ng \u0111\u1ea7u ti\u00ean sau khi b\u00ea\u0323nh nh\u00e2n \u0111\u01b0\u01a1\u0323c ch\u1ea9n \u0111o\u00e1n HF (Heart Failure, suy tim) ho\u1eb7c suy tim m\u1ea5t b\u00f9 v\u00e0 se\u0303 gi\u1ea3m ch\u01b0\u0301c n\u0103ng tim trong v\u00f2ng 6 th\u00e1ng sau khi h\u00ea\u0301t giai \u0111oa\u0323n c\u1ea5p t\u00ednh [4]. Loa\u0323i y\u00ea\u0301u t\u00f4\u0301 prothrombin \u1edf b\u1ec7nh nh\u00e2n HF xu\u00e2\u0301t hi\u00ea\u0323n c\u00f3 th\u1ec3 l\u00e0 do (1) ph\u1ea3n \u1ee9ng vi\u00eam to\u00e0n th\u00e2n do thi\u1ebfu oxy m\u1ea1n t\u00ednh, (2) t\u0103ng n\u1ed3ng \u0111\u1ed9 ph\u00e2n t\u1eed prothrombin, ho\u1eb7c (3) r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00f4\u0323i ma\u0323c \u0111\u1ed9ng m\u1ea1ch v\u00e0 t\u0129nh m\u1ea1ch.<\/p>\n

\"nh\u01b0\u0303ng<\/p>\n

Suy tim c\u0169ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp co\u0301 th\u00ea\u0309 d\u00e2\u0303n \u0111\u00ea\u0301n t\u00ecnh tr\u1ea1ng ta\u0300n t\u00e2\u0323t n\u0103\u0323ng n\u00ea\u0300 h\u01a1n, t\u0103ng ty\u0309 l\u00ea\u0323 t\u00e1i nh\u1eadp vi\u1ec7n v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong cao h\u01a1n sau \u0111\u1ed9t qu\u1ef5. M\u1eb7c d\u00f9 v\u1eady, hi\u00ea\u0323n v\u00e2\u0303n ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u1eabn r\u00f5 r\u00e0ng v\u00ea\u0300 vai tr\u00f2 c\u1ee7a thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u v\u00e0 ch\u1ed1ng k\u00ea\u0301t t\u00e2\u0323p ti\u1ec3u c\u1ea7u trong vi\u00ea\u0323c gia\u0309m ty\u0309 l\u00ea\u0323 ta\u0300n t\u00e2\u0323t va\u0300 t\u01b0\u0309 vong do ca\u0301c b\u1ea5t th\u01b0\u1eddng v\u00ea\u0300 \u0111\u00f4ng m\u00e1u trong HF [1]. T\u0103ng nguy c\u01a1 bi\u1ebfn ch\u1ee9ng huy\u1ebft kh\u1ed1i trong b\u00ea\u0323nh ca\u0309nh HF l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c l\u00e2m s\u00e0ng ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u0111\u00fang m\u1ee9c, do HF (Heart Failure, suy tim) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi ti\u0300nh tra\u0323ng t\u0103ng \u0111\u00f4ng c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam m\u01b0\u0301c \u0111\u00f4\u0323 ta\u0300n t\u00e2\u0323t v\u00e0 t\u1eed vong.<\/p>\n

Ki\u1ec3m so\u00e1t l\u00e2m s\u00e0ng c\u00e1c r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u trong HF<\/h2>\n

\u1ede c\u00e1c b\u1ec7nh nh\u00e2n suy tim, d\u1ea5u \u1ea5n hoa\u0323t ho\u0301a \u0111\u00f4ng m\u00e1u v\u00e0\/ho\u1eb7c ho\u1ea1t h\u00f3a ti\u1ec3u c\u1ea7u \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u00e2\u0323n th\u1ea5y la\u0300 co\u0301 \u0111i c\u00f9ng v\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u1ed9i ma\u0323c ma\u0323ch v\u00e0 cung l\u01b0\u1ee3ng tim th\u1ea5p, c\u00e1c t\u00ecnh tr\u1ea1ng li\u00ean quan \u0111\u1ebfn l\u01b0u l\u01b0\u1ee3ng m\u00e1u b\u1ea5t th\u01b0\u1eddng v\u00e0 s\u1ef1 \u1ee9 tr\u00ea\u0323 tu\u00e2\u0300n hoa\u0300n. H\u01a1n n\u1eefa, m\u1ed9t s\u1ed1 b\u1ec7nh ke\u0300m theo th\u01b0\u1eddng l\u00e0m ph\u1ee9c t\u1ea1p th\u00eam b\u00ea\u0323nh ca\u0309nh HF, l\u00e0m t\u0103ng th\u00eam nguy c\u01a1 t\u0103\u0301c ma\u0323ch do huy\u1ebft kh\u1ed1i.<\/p>\n

D\u1ef1 ph\u00f2ng t\u0103\u0301c ma\u0323ch do huy\u1ebft kh\u1ed1i b\u1eb1ng heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n \u0111i\u00ea\u0300u tri\u0323 n\u00f4\u0323i tru\u0301 \u0111\u01b0\u01a1\u0323c ch\u00e2\u0309n \u0111oa\u0301n HF c\u1ea5p kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc ke\u0301o d\u00e0i [1]. Trong th\u1eadp k\u1ef7 qua, nh\u01b0\u0303ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u01a1\u0300ng u\u00f4\u0301ng tr\u01b0\u0323c ti\u00ea\u0301p (direct oral anticoagulants, DOACs) c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t qu\u1ef5 v\u00e0 t\u1eafc m\u1ea1ch to\u00e0n th\u00e2n (SSE) \u1edf AF (Atrial Fibrillation, rung nhi\u0303) kh\u00f4ng do van tim. Nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y l\u00e0 thu\u00f4\u0301c thay th\u1ebf cho warfarin v\u1edbi nguy c\u01a1 ch\u1ea3y m\u00e1u th\u00e2\u0301p h\u01a1n [3].<\/p>\n

S\u01b0\u0309 du\u0323ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng cho b\u1ec7nh nh\u00e2n AF v\u00e0 HF \u0111\u01b0\u1ee3c coi l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 cao t\u0103\u0301c ma\u0323ch do huy\u1ebft kh\u1ed1i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. C\u00e1c h\u01b0\u1edbng d\u1eabn ESC (European Society of Cardiology, Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Ch\u00e2u \u00c2u) khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng DOAC thay v\u00ec Warfarin \u0111\u1ec3 ng\u0103n ng\u1eeba \u0111\u1ed9t qu\u1ef5 \u1edf AF, v\u00ec c\u00e1c thu\u1ed1c n\u00e0y cho hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0ng an to\u00e0n v\u00ea\u0300 m\u0103\u0323t l\u00e2m sa\u0300ng h\u01a1n. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n HF c\u00f3 \u00edt xu\u00e2\u0301t hi\u00ea\u0323n trong c\u00e1c th\u1eed nghi\u1ec7m \u0111\u1ed1i ch\u1ee9ng ng\u1eabu nhi\u00ean [3].<\/p>\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n HF c\u00f3 AF (Atrial Fibrillation, rung nhi\u0303), ch\u00ea\u0301 ph\u00e2\u0309m DOACs h\u01b0 Apixaban v\u00e0 Dabigatran (kh\u00f4ng ph\u1ea3i Rivaroxaban) c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u to\u00e0n ph\u1ea7n v\u00e0 t\u1eed vong th\u1ea5p h\u01a1n Warfarin v\u01a1\u0301i t\u1ea5t c\u1ea3 c\u00e1c m\u1ee9c ch\u1ee9c n\u0103ng lo\u0323c c\u00e2\u0300u th\u1eadn. M\u1eb7c d\u00f9 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng DOAC \u00edt ph\u1ee9c t\u1ea1p h\u01a1n nhi\u00ea\u0300u so v\u1edbi Warfarin, vi\u1ec7c s\u1eed d\u1ee5ng thu\u00f4\u0301c na\u0300y \u1edf b\u1ec7nh nh\u00e2n HF kh\u00f4ng ph\u1ea3i la\u0300 c\u01b0\u0301 k\u00ea va\u0300 du\u0300ng thu\u00f4\u0301c kh\u00f4ng ki\u00ea\u0309m soa\u0301t. Ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng thay \u0111\u00f4\u0309i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n HF, \u0111\u00f4i khi c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u DOAC, nh\u01b0ng nh\u1eefng \u0111i\u1ec1u ch\u1ec9nh n\u00e0y kh\u00f4ng th\u01b0\u1eddng xuy\u00ean xa\u0309y ra tr\u00ean l\u00e2m sa\u0300ng. Ngay c\u1ea3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn \u01a1\u0309 m\u01b0\u0301c th\u00e2\u0301p nh\u00e2\u0301t c\u0169ng c\u00f3 th\u00ea\u0309 d\u00e2\u0303n \u0111\u1ebfn t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u \u1edf<\/p>\n

\"b\u1ec7nh<\/p>\n

Ch\u0103m s\u00f3c chuy\u00ean s\u00e2u trong ta\u0323i ca\u0301c ph\u00f2ng kh\u00e1m \u0111i\u00ea\u0300u tri\u0323 ho\u1eb7c d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng co\u0301 chuy\u00ean m\u00f4n v\u00ea\u0300 ch\u1ed1ng \u0111\u00f4ng m\u00e1u giu\u0301p \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u DOAC v\u00e0 cho k\u1ebft qu\u1ea3 t\u00f4\u0301t h\u01a1n. Nghi\u00ean c\u1ee9u th\u00eam v\u1ec1 c\u00e1c kh\u00e1c bi\u1ec7t quan s\u00e1t \u0111\u01b0\u1ee3c trong hi\u1ec7u qu\u1ea3 gi\u1eefa c\u00e1c \u0111i\u1ec3m nghi\u00ean c\u1ee9u c\u00f3 th\u1ec3 cung c\u1ea5p c\u01a1 h\u1ed9i \u0111\u1ec3 c\u1ea3i thi\u1ec7n h\u01a1n n\u1eefa ch\u1ea5t l\u01b0\u1ee3ng ch\u0103m s\u00f3c cho b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng DOAC [4].<\/p>\n

Nhu c\u1ea7u nghi\u00ean c\u1ee9u s\u00e2u h\u01a1n<\/h2>\n

V\u1edbi t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh tr\u00ean to\u00e0n th\u1ebf gi\u1edbi l\u00e0 1%-2%, HF l\u00e0 m\u1ed9t c\u0103n b\u1ec7nh to\u00e0n c\u1ea7u l\u01a1\u0301n, d\u1ef1 ti\u0301nh s\u1ebd g\u00e2y \u1ea3nh h\u01b0\u1edfng tr\u00ean h\u01a1n 8 tri\u1ec7u ng\u01b0\u1eddi tr\u01b0\u01a1\u0309ng tha\u0300nh v\u00e0 t\u1ed5ng chi ph\u00ed do HF \u01b0\u1edbc t\u00ednh s\u1ebd t\u0103ng l\u00ean 70 t\u1ef7 \u0111\u00f4 la v\u00e0o n\u0103m 2030. B\u00e2\u0301t ch\u00e2\u0301p nh\u1eefng ti\u1ebfn b\u1ed9 d\u1ef1a tr\u00ean y ho\u0323c b\u1eb1ng ch\u1ee9ng g\u1ea7n \u0111\u00e2y trong qu\u1ea3n l\u00fd HF, ch\u1eb3ng h\u1ea1n nh\u01b0 vi\u1ec7c k\u1ebft h\u1ee3p m\u00e1y kh\u1eed rung tim c\u1ea5y gh\u00e9p v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ta\u0323o nhi\u0323p ta\u0301i \u0111\u1ed3ng b\u1ed9 c\u01a1 tim, t\u1ef7 l\u1ec7 t\u1eed vong li\u00ean quan \u0111\u1ebfn HF v\u1eabn \u1edf m\u1ee9c cao, kho\u1ea3ng 50% trong vo\u0300ng 5 n\u0103m \u0111i\u00ea\u0300u tri\u0323.<\/p>\n

Do b\u1ec7nh nh\u00e2n HF c\u00f3 nguy c\u01a1 huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch cao, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00f3 tri\u00ea\u0323u ch\u01b0\u0301ng AF (Atrial Fibrillation, rung nhi\u0303), \u0111i\u1ec1u tr\u1ecb b\u0103\u0300ng DOAC d\u01b0\u1eddng nh\u01b0 tr\u01a1\u0309 tha\u0300nh m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p h\u1ee3p l\u00fd \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 bi\u1ebfn c\u1ed1 huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch co\u0301 chi\u0309 s\u00f4\u0309 an to\u00e0n t\u1ed1t. Tuy nhi\u00ean, do thi\u1ebfu d\u1eef li\u1ec7u c\u1ee5 th\u1ec3, c\u00e1c quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng hi\u1ec7n nay \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng t\u1eeb RCTs (Randomized Controlled Trial, c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean co\u0301 \u0111\u00f4\u0301i ch\u01b0\u0301ng) quy m\u00f4 l\u1edbn tr\u00ean qu\u1ea7n th\u1ec3 m\u0103\u0301c AF (Atrial Fibrillation, rung nhi\u0303) n\u00f3i chung.<\/p>\n

M\u1ed9t s\u1ed1 c\u00e2u h\u1ecfi quan tr\u1ecdng v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i \u0111\u00e1p v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng DOACs trong HF v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ph\u00e2n ti\u0301ch s\u00e2u h\u01a1n. Li\u1ec7u DOAC c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nh\u00e2\u0301t \u0111i\u0323nh \u0111\u00ea\u0301n c\u00e1c k\u1ebft c\u1ee5c HF, ch\u1eb3ng h\u1ea1n nh\u01b0 l\u00e0m n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng suy tim ho\u1eb7c nh\u1eadp vi\u1ec7n kh\u00f4ng? Ch\u00fang ta n\u00ean qu\u1ea3n l\u00fd ch\u1ed1ng \u0111\u00f4ng nh\u01b0 th\u1ebf n\u00e0o \u1edf b\u1ec7nh nh\u00e2n HF co\u0301 AF (Atrial Fibrillation, rung nhi\u0303) va\u0300 b\u1ec7nh l\u00fd \u0111i k\u00e8m? Ch\u00fang ta n\u00ean k\u1ebft h\u1ee3p thu\u1ed1c ch\u1ed1ng k\u00ea\u0301t t\u00e2\u0323p ti\u1ec3u c\u1ea7u v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng nh\u01b0 th\u1ebf n\u00e0o \u1edf b\u1ec7nh nh\u00e2n HF-AF-CAD (Coronary Artery Disease, B\u00ea\u0323nh \u0111\u00f4\u0323ng ma\u0323ch va\u0300nh)? Li\u1ec7u ch\u00fang ta c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng DOAC m\u1ed9t c\u00e1ch an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 \u1edf b\u1ec7nh nh\u00e2n HF co\u0301 AF c\u00f3 huy\u1ebft kh\u1ed1i th\u1ea5t tr\u00e1i kh\u00f4ng? Khi n\u00e0o n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb DOAC \u1edf b\u1ec7nh nh\u00e2n HF nguy c\u01a1 cao co\u0301 \u0111\u00f4\u0300ng th\u01a1\u0300i c\u1ea3 huy\u1ebft kh\u1ed1i th\u1ea5t tr\u00e1i v\u00e0 AF?<\/p>\n

HF l\u00e0 m\u1ed9t b\u00ea\u0323nh c\u1ea3nh l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t \u0111\u00f2i h\u1ecfi c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng c\u00f3 m\u1ee5c ti\u00eau cu\u0323 th\u00ea\u0309 v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p \u0111\u1ec3 h\u1ea1n ch\u1ebf c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i. Nh\u1eefng nghi\u00ean c\u1ee9u nh\u01b0 v\u1eady s\u1ebd gi\u00fap \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng v\u00ea\u0300 vi\u00ea\u0323c ch\u1ecdn DOAC \u0111\u00ea\u0309 \u0111i\u00ea\u0300u tri\u0323 b\u1ec7nh nh\u00e2n suy tim tr\u00ean di\u00ea\u0323n r\u00f4\u0323ng v\u00e0 trong c\u00e1c t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng ri\u00eang bi\u1ec7t. [3]<\/p>\n

*DOACs: ISTH (International Society on Thrombosis and Haemostasis, Hi\u1ec7p h\u1ed9i Huy\u1ebft kh\u1ed1i v\u00e0 C\u1ea7m m\u00e1u Qu\u1ed1c t\u1ebf) SSC (Scientific and Standardization Committee, H\u00f4\u0323i \u0111\u00f4\u0300ng khoa ho\u0323c va\u0300 chu\u00e2\u0309n ho\u0301a) n\u0103m 2023 khuy\u1ebfn ngh\u1ecb m\u00f4 t\u1ea3 thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u theo ph\u01b0\u01a1ng th\u01b0\u0301c ki\u00ea\u0309m soa\u0301t v\u00e0 m\u1ee5c ti\u00eau \u0111i\u00ea\u0300u tri\u0323 c\u1ee5 th\u1ec3 (v\u00ed d\u1ee5: thu\u1ed1c \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 Xia \u0111\u01b0\u1eddng u\u1ed1ng, thu\u1ed1c \u1ee9c ch\u1ebf y\u1ebfu t\u1ed1 XIIa \u0111\u01b0\u1eddng ti\u00eam). (5)<\/em><\/p>\n

T\u00e0i<\/em>LI\u1ec6U THAM KH\u1ea2O:<\/p>\n

[1]<\/a>\u00a0SINIARSKI, A. et al. (2023) ‘R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u trong suy tim: T\u1eeb khoa h\u1ecdc c\u01a1 b\u1ea3n \u0111\u1ebfn quan \u0111i\u1ec3m l\u00e2m s\u00e0ng’, Journal of Cardiac Failure, 29(4), pp. 517-526. doi:10.1016\/j.cardfail.2022.12.012.<\/p>\n

[2]<\/a>\u00a0Kim, J.H. et al. (2016) ‘Nh\u1eefng b\u1ea5t th\u01b0\u1eddng v\u1ec1 \u0111\u00f4ng m\u00e1u trong suy tim: Sinh b\u00ea\u0323nh ho\u0323c v\u00e0 \u00fd ngh\u0129a \u0111i\u1ec1u tr\u1ecb’, B\u00e1o c\u00e1o suy tim hi\u1ec7n t\u1ea1i, 13(6), trang 319\u2013328. doi:10.1007\/s11897-016-0308-6.<\/p>\n

[3]<\/a>\u00a0Paolillo, S. et al. (2020) ‘Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng tr\u1ef1c ti\u1ebfp tr\u00ean to\u00e0n b\u1ed9 ph\u1ed5 suy tim: K\u1ef7 nguy\u00ean Y h\u1ecdc ch\u00ednh x\u00e1c’, \u0110\u00e1nh gi\u00e1 suy tim, 27(1), trang 135\u2013145. doi:10.1007\/s10741-020-09994-0.<\/p>\n

[4]<\/a>\u00a0Jackevicius, C.A. et al. (2021) ‘Nguy c\u01a1 ch\u1ea3y m\u00e1u do thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng tr\u1ef1c ti\u1ebfp \u1edf b\u1ec7nh nh\u00e2n co\u0301 suy tim v\u00e0 rung nh\u0129’, Tu\u1ea7n ho\u00e0n: Ch\u1ea5t l\u01b0\u1ee3ng v\u00e0 K\u1ebft qu\u1ea3 Tim m\u1ea1ch, 14(2). doi:10.1161\/circoutcomes.120.007230.<\/p>\n

[5]\u00a0<\/a>Barnes, G.D. et al. (2023) ‘Khuy\u1ebfn ngh\u1ecb v\u1ec1 danh ph\u00e1p cho thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng: Th\u00f4ng b\u00e1o c\u1eadp nh\u1eadt t\u1eeb \u1ee6y ban khoa h\u1ecdc v\u00e0 ti\u00eau chu\u1ea9n h\u00f3a c\u1ee7a Hi\u1ec7p h\u1ed9i qu\u1ed1c t\u1ebf v\u1ec1 huy\u1ebft kh\u1ed1i v\u00e0 c\u1ea7m m\u00e1u v\u1ec1 ki\u1ec3m so\u00e1t thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng’, T\u1ea1p ch\u00ed v\u00ea\u0300 Huy\u1ebft kh\u1ed1i v\u00e0 C\u1ea7m m\u00e1u, 21(5), trang 1381\u20131384. doi:10.1016\/j.jtha.2023.02.008.<\/p>\n","protected":false},"excerpt":{"rendered":"

R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u trong suy tim Suy tim (Heart Failure, HF) l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng g\u00e2y ra b\u1edfi r\u1ed1i lo\u1ea1n c\u1ea5u tr\u00fac ho\u1eb7c ch\u1ee9c n\u0103ng c\u1ee7a tim d\u1eabn \u0111\u1ebfn \u00e1p l\u01b0\u0323c co bo\u0301p cu\u0309a tim t\u0103ng v\u00e0 \/ ho\u1eb7c cung l\u01b0\u1ee3ng tim kh\u00f4ng \u0111\u1ee7 trong qu\u00e1 tr\u00ecnh t\u1eadp th\u1ec3 d\u1ee5c ho\u1eb7c ngh\u1ec9 […]<\/p>\n","protected":false},"author":1,"featured_media":85850,"parent":0,"menu_order":0,"template":"","meta":{"_acf_changed":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"tags":[14793,14860],"pillarandcategory":[283,292,282],"reporter":[14949,14950],"class_list":["post-147102","acf_article","type-acf_article","status-publish","has-post-thumbnail","hentry","tag-dong-mau","tag-tim-mach","pillarandcategory-cardiology","pillarandcategory-coagulation","pillarandcategory-disease-area","reporter-niti-dawar","reporter-yingli-huang"],"acf":[],"_links":{"self":[{"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/acf_article\/147102","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/acf_article"}],"about":[{"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/types\/acf_article"}],"author":[{"embeddable":true,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/users\/1"}],"version-history":[{"count":4,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/acf_article\/147102\/revisions"}],"predecessor-version":[{"id":149178,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/acf_article\/147102\/revisions\/149178"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/media\/85850"}],"wp:attachment":[{"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/media?parent=147102"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/tags?post=147102"},{"taxonomy":"pillarandcategory","embeddable":true,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/pillarandcategory?post=147102"},{"taxonomy":"reporter","embeddable":true,"href":"https:\/\/labinsights.com\/vi\/wp-json\/wp\/v2\/reporter?post=147102"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}