低强度与低强度的对比 超导管大动脉置换后高强度抗血栓治疗:随机对照试验的元分析
Tarun Chakravarty1, Derek Leong1, Angelo de la Rosa1
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Structural heart : the journal of the Heart Team
|June 5, 2023
概括
过导管大动脉置换 (TAVR) 后的高强度抗血栓治疗增加了死亡,血栓栓塞和出血的风险. 低强度疗法对于没有抗凝药特征的患者来说更安全.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 最佳的抗血栓治疗方法在透气管后的大动脉置换 (TAVR) 仍在争论中.
- 目前的指导方针缺乏关于抗血栓治疗强度的共识,因为缺乏抗凝固药物的明确指示.
研究的目的:
- 系统地审查和元分析随机对照试验,比较高强度与低强度抗血栓治疗后的TAVR.
- 评估不同抗血栓策略的有效性和安全性,在没有确定的抗凝药指示的情况下接受TAVR的患者中.
主要方法:
- 随机对照试验的系统审查和元分析.
- 纳入标准:研究比较高强度与低强度的抗血栓治疗TAVR后在缺乏抗凝血指示的情况下.
- 主要终点:死亡或血栓塞栓事件的组合,以及门学术研究联盟2定义的显著出血. 使用治疗意图和随机效应模型进行分析.
主要成果:
- 分析了四项涉及3358名患者的试验.
- 与高强度治疗相比,低强度的抗血栓治疗与死亡或血栓栓事件的显着较低率 (RR 0.66;95% CI 0.55-0.80) 相关.
- 接受低强度治疗的患者也明显减少了死亡 (RR 0.68;95% CI 0.51-0.92) 和严重出血 (RR 0.69;95% CI 0.48-1.00).
结论:
- 高强度抗血栓药物治疗TAVR后在老年患者没有抗凝固药物的特定迹象的例行治疗与风险增加有关.
- 在TAVR后常规启动抗凝药或双抗血小板治疗可能不建议.
- 在这种患者群体中,低强度的抗血栓策略似乎更安全,更有效.
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