[1]张木馨 李丽英 阮海燕 何森.经导管主动脉瓣置换术后抗栓治疗进展[J].心血管病学进展,2022,(6):518.[doi:10.16806/j.cnki.issn.1004-3934.2022.06.010]
 ZHANG Muxin,LI Liying,RUAN Haiyan,et al.Progress of Antithrombotic Therapy after?ranscatheter Aortic Valve Replacement[J].Advances in Cardiovascular Diseases,2022,(6):518.[doi:10.16806/j.cnki.issn.1004-3934.2022.06.010]
点击复制

经导管主动脉瓣置换术后抗栓治疗进展()
分享到:

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年6期
页码:
518
栏目:
综述
出版日期:
2022-06-25

文章信息/Info

Title:
Progress of Antithrombotic Therapy after?ranscatheter Aortic Valve Replacement
作者:
张木馨12 李丽英1 阮海燕13 何森1
(1.四川大学华西医院心血管内科,四川 成都 610041;2.四川大学华西医院龙泉医院心血管内科,四川 成都 610100;3.成都市双流区中医医院心血管内科,四川 成都 610200)
Author(s):
ZHANG Muxin12LI Liying1RUAN Haiyan13HE Sen1
?1.Department of Cardiology,West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China2.Department of Cardiology,Longquan Hospital,West China Hospital of Sichuan University,Chengdu 610100,Sichuan,China3.Department of Cardiology,Traditional Chinese Medicine Hospital of Shuangliu District,Chengdu 610200,Sichuan,China)
关键词:
经导管主动脉瓣置换术抗栓治疗缺血事件出血事件
Keywords:
Transcatheter aortic valve replacement Antithrombotic therapy Ischemic events Bleeding events
DOI:
10.16806/j.cnki.issn.1004-3934.2022.06.010
摘要:
经导管主动脉瓣置换术(TAVR)是严重主动脉瓣狭窄患者的一种治疗选择。TAVR术后存在血栓事件风险,需长期口服抗栓药物,但行TAVR的患者大部分系基础疾病多及合并多种并发症的老年人,长期服用抗栓药物易导致出血风险增加,这使抗栓治疗方案变得复杂;因此,确定最佳抗栓治疗方案尤为重要。目前常见的抗栓策略包括单药抗血小板治疗、双联抗血小板治疗及口服抗凝药物治疗等。作为一个近年来新兴发展的手术方式,TAVR术后血栓及出血风险评估尚缺乏明确的循证医学证据,鉴于此,笔者团队针对TAVR术后抗栓治疗做综述分析。
Abstract:
Transcatheter aortic valve replacement (TAVR) is a treatment option for patients with severe aortic stenosis. There is a risk of thrombotic events after TAVR,which requires long-term oral antithrombotic drugs. However,most of the patients undergoing TAVR are elderly with multiple underlying diseases and complications,and long-term use of antithrombotic drugs is prone to increase the risk of bleeding,which makes the antithrombotic treatment plan complicated. Therefore,it is very important to determine the best antithrombotic treatment. At present,common antithrombotic strategies include single drug antiplatelet therapy,dual antiplatelet therapy and oral anticoagulant therapy. As a newly developed surgical method in recent years,there is still a lack of clear evidence-based evidence for the risk assessment of postoperative thrombosis and hemorrhage after TAVR. In view of this,we conducted a review and analysis of postoperative antithrombotic therapy for TAVR

参考文献/References:

[1] 周达新,潘文志,吴永健,等. 经导管主动脉瓣置换术中国专家共识(2020更新版)[J]. 中国介入心脏病学杂志,2020,28(6):301-309.
[2] Leon MB,Mack MJ,Hahn RT,et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk[J]. J Am Coll Cardiol,2021,77(9):1149-1161.
[3] van Mieghem NM,Schipper ME,Ladich E,et al. Histopathology of embolic debris captured during transcatheter aortic valve replacement[J]. Circulation,2013,127(22):2194-2201.
[4] Chakravarty T,S?ndergaard L,Friedman J,et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves:an observational study[J]. Lancet,2017,389(10087):2383-2392.
[5] Généreux P,Cohen DJ,Mack M,et al. Incidence,predictors,and prognostic impact of late bleeding complications after transcatheter aortic valve replacement[J]. J Am Coll Cardiol,2014,64(24):2605-2615.
[6] Otto CM,Nishimura RA,Bonow RO,et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease:A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. J Am Coll Cardiol,2021,77(4):e25-e197.
[7] Chakravarty T,Patel A,Kapadia S,et al. Anticoagulation after surgical or transcatheter bioprosthetic aortic valve replacement[J]. J Am Coll Cardiol,2019,74(9):1190-1200.
[8] Vahanian A,Beyersdorf F,Praz F,et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur J Cardiothorac Surg,2021,60(4):727-800.
[9] Carroll JD,Mack MJ,Vemulapalli S,et al. STS-ACC TVT registry of transcatheter aortic valve replacement[J]. Ann Thorac Surg,2021,111(2):701-722.
[10] Makkar RR,Blanke P,Leipsic J,et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves:PARTNER 3 cardiac computed tomography substudy[J]. J Am Coll Cardiol,2020,75(24):3003-3015.
[11] Mentias A,Desai MY,Saad M,et al. Incidence and outcomes of acute coronary syndrome after transcatheter aortic valve replacement[J]. JACC Cardiovasc Interv,2020,13(8):938-950.
[12] Isogai T,Saad AM,Ahuja KR,et al. Incidence,treatment,and outcomes of acute myocardial infarction following transcatheter or surgical aortic valve replacement[J]. Catheter Cardiovasc Interv,2022;99(3):877-888.
[13] Panchal HB,Ladia V,Desai S,et al. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis[J]. Am J Cardiol,2013,112(6):850-860.
[14] Arai T,Romano M,Lefevre T,et al. Direct comparison of feasibility and safety of transfemoral versus transaortic versus transapical transcatheter aortic valve replacement[J]. JACC Cardiovasc Interv,2016,9(22):2320-2325.
[15] Piccolo R,Pilgrim T,Franzone A,et al. Frequency,timing,and impact of access-site and non-access-site bleeding on mortality among patients undergoing transcatheter aortic valve replacement[J]. JACC Cardiovasc Interv,2017,10(14):1436-1446.
[16] Rodes-Cabau J,Masson JB,Welsh RC,et al. Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve:the ARTE(aspirin versus aspirin+clopidogrel following transcatheter aortic valve implantation) randomized vlinical trial[J]. JACC Cardiovasc Interv,2017,10(13):1357-1365.
[17] Brouwer J,Nijenhuis VJ,Delewi R,et al.Aspirin with or without vlopidogrel after transcatheter aortic-valve implantation[J]. N Engl J Med,2020,383(15):1447-1457.
[18] Stabile E,Pucciarelli A,Cota L,et al. SAT-TAVI(single antiplatelet therapy for TAVI) study:a pilot randomized study comparing double to single antiplatelet therapy for transcatheter aortic valve implantation[J]. Int J Cardiol,2014,174(3):624-627.
[19] Dangas GD,Tijssen JGP,Wohrle J,et al. A controlled rrial of rivaroxaban after transcatheter aortic-valve replacement[J]. N Engl J Med,2020,382(2):120-129.
[20] Park H,Kang DY,Ahn JM,et al. Rationale and design of the ADAPT-TAVR trial:a randomised comparison of edoxaban and dual antiplatelet therapy for prevention of leaflet thrombosis and cerebral embolisation after transcatheter aortic valve replacement[J]. BMJ Open,2021,11(1):e042587.
[21] Kuno T,Takagi H,Sugiyama T,et al. Antithrombotic strategies after transcatheter aortic valve implantation:insights from a network meta-analysis[J]. Catheter Cardiovasc Interv,2020,96(2):E177-E186.
[22] Valgimigli M,Bueno H,Byrne RA,et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS[J]. Eur J Cardiothorac Surg,2018,53(1):34-78.
[23] Ten Berg J,Sibbing D,Rocca B,et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation:a consensus document of the ESC working group on thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI),in collaboration with the ESC council on valvular heart disease[J]. Eur Heart J,2021,42(23):2265-2269.
[24] Abdul-Jawad Altisent O,Durand E,Mu?oz-García AJ,et al. Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement[J]. JACC Cardiovasc Interv,2016,9(16):1706-1717.
[25]Nijenhuis VJ,Bennaghmouch N,Hassell M,et al. Rationale and design of POPular-TAVI:antiPlatelet therapy fOr Patients undergoing Transcatheter Aortic Valve Implantation[J]. Am Heart J,2016,173:77-85.
[26] Collet JP,Berti S,Cequier A,et al. Oral anti-Xa anticoagulation after trans-aortic valve implantation for aortic stenosis:the randomized ATLANTIS trial[J]. Am Heart J,2018,200:44-50.
[27] van Mieghem NM,Unverdorben M,Valgimigli M,et al. Edoxaban versus standard of care and their effects on clinical outcomes in patients having undergone transcatheter aortic valve implantation in atrial fibrillation-rationale and design of the ENVISAGE-TAVI AF trial[J]. Am Heart J,2018,205:63-69.
[28] van Mieghem NM,Unverdorben M,Hengstenberg C,et al. Edoxaban versus vitamin K antagonist for atrial fibrillation after TAVR[J]. N Engl J Med,2021,385(23):2150-2160.
[29] Makkar RR,Fontana G,Jilaihawi H,et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves[J]. N Engl J Med,2015,373(21):2015-2024.

相似文献/References:

[1]于子凯 许海燕 刘庆荣 吴永健.合并常见疾病对经导管主动脉瓣置换术患者预后的影响[J].心血管病学进展,2019,(5):697.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.009]
 YU Zikai,XU Haiyan,LIU Qingrong,et al.Influence of ommon Accompanied Diseases on Prognosis of Patients after Transcatheter Aortic Valve Replacement[J].Advances in Cardiovascular Diseases,2019,(6):697.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.009]
[2]王斯佳 王国兴.抗栓治疗后消化道出血的现状及抗栓策略[J].心血管病学进展,2020,(8):790.[doi:10.16806/j.cnki.issn.1004-3934.2020.08.002]
 WANG Sijia,WANG G uoxing.Current Characteristics and Anti-thrombotic Strategy of Gastrointestinal Hemorrhage after Anti-thrombotic Therapy[J].Advances in Cardiovascular Diseases,2020,(6):790.[doi:10.16806/j.cnki.issn.1004-3934.2020.08.002]
[3]邵美华 周玉强 王萌萌 王宝珠 马翔.经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄研究进展[J].心血管病学进展,2020,(11):1184.[doi:10.16806/j.cnki.issn.1004-3934.2020.11.000]
[4]刘新民 宋光远 吴永健.左心室导丝起搏技术在经导管主动脉瓣置换术中的应用[J].心血管病学进展,2021,(4):289.[doi:10.16806/j.cnki.issn.1004-3934.2021.04.001]
 LIU Xinmin,SONG Guangyuan,WU Yongjian.Application of Left Ventricular Guidewire Pacing in Transcatheter Aortic Valve Replacement[J].Advances in Cardiovascular Diseases,2021,(6):289.[doi:10.16806/j.cnki.issn.1004-3934.2021.04.001]
[5]陈阳 赵庆豪 赵杰 吴永健.经导管主动脉瓣置换术时代慢性主动脉瓣反流诊治进展[J].心血管病学进展,2022,(1):1.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.001]
 CHEN Yang,ZHAO Qinghao,SONG Guangyuan,et al.Diagnosis and Treatment of Chronic Aortic Regurgitation in Transcatheter Aortic Valve Replacement Era[J].Advances in Cardiovascular Diseases,2022,(6):1.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.001]
[6]索妮 杨艳敏.心房颤动合并慢性冠状动脉综合征的抗栓治疗进展[J].心血管病学进展,2022,(1):30.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.008]
 SUO Ni,Y ANG Yanmin.Antithrombotic Therapy for Atrial Fibrillation Complicated with Chronic Coronary Syndrome[J].Advances in Cardiovascular Diseases,2022,(6):30.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.008]
[7]董一娜 雷芳芳 宋启煦 王晶 杨艳.经导管主动脉瓣置换术后死亡风险预测模型系统评价[J].心血管病学进展,2022,(1):76.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.020]
 DONG Yina,LEI Fangfang,SONG Qixu,et al.Mortality Risk Prediction Models After Transcatheter?span>Aortic Valve Replacement:A Systematic Review[J].Advances in Cardiovascular Diseases,2022,(6):76.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.020]
[8]王卫卫 于子凯 吴永健 许海燕 刘庆荣.序贯综合心脏康复模式在经导管主动脉瓣置换术患者中应用现状[J].心血管病学进展,2022,(8):673.[doi:10.16806/j.cnki.issn.1004-3934.2022.08.001]
 WANG Weiwei,YU Zikai,WU YongjianXU HaiyanLIU Qingrong.The Status of Sequential Comprehensive Cardiac Rehabilitation in Patients?ndergoing Transcatheter Aortic Valve Replacement[J].Advances in Cardiovascular Diseases,2022,(6):673.[doi:10.16806/j.cnki.issn.1004-3934.2022.08.001]
[9]张航 安景辉 石凤梧.极简式经导管主动脉瓣置换术的研究现状[J].心血管病学进展,2022,(9):812.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.011]
 ZHANG Hang,AN Jinghui,SHI Fengwu.Minimalist Transcatheter Aortic Valve Replacement[J].Advances in Cardiovascular Diseases,2022,(6):812.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.011]
[10]金冉阳 刘德敏 崔炜.经皮冠状动脉介入治疗围手术期抗栓治疗的演变[J].心血管病学进展,2023,(1):39.[doi:10.16806/j.cnki.issn.1004-3934.2023.01.010]
 JIN Ranyang,LIU Demin,CUI Wei.Evolution of Antithrombotic Therapy During Perioperative PCI[J].Advances in Cardiovascular Diseases,2023,(6):39.[doi:10.16806/j.cnki.issn.1004-3934.2023.01.010]
[11]李宗泽 何贵均 郑晓菲 蒋晖 刘汉雄.经导管主动脉瓣置换术后合并心房颤动的抗栓策略[J].心血管病学进展,2021,(10):892.[doi:10.16806/j.cnki.issn.1004-3934.2021.10.007]
 LI ZongzeHE GuijunZHENG XiaofeiJIANG HuiLIU Hanxiong.Optimal Antithrombotic Strategies after Transcatheter Aortic Valve Replacement in Patients with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2021,(6):892.[doi:10.16806/j.cnki.issn.1004-3934.2021.10.007]
[12]. 经导管主动脉瓣置换术术后抗栓治疗的研究进展 [J].心血管病学进展,2022,(7):577.[doi:10.16806/j.cnki.issn.1004-3934.2022.07.000]
 DUAN ZhenyaWU Yongjian.Antithrombotic Therapy After Transcatheter Aortic Valve Implantation[J].Advances in Cardiovascular Diseases,2022,(6):577.[doi:10.16806/j.cnki.issn.1004-3934.2022.07.000]

备注/Memo

备注/Memo:
基金项目:国家自然科学基金(81600299);四川省科技计划(2022YFS0186)收稿日期:2021-12-05
更新日期/Last Update: 2022-08-05