最佳的抗血小板和抗血栓治疗方案是通过透气管进行大动脉置换后的
Melissa Y Y Moey1,2, Kunjan Udani1, L Wiley Nifong3
1Department of Cardiovascular Disease, East Carolina University (ECU), Greenville, North Carolina, USA.
European journal of clinical investigation
|August 4, 2023
概括
过导管大动脉置换 (TAVR) 后的双重抗血小板治疗 (DAPT) 可能会增加死亡或缺血的风险,特别是在没有冠状动脉疾病的患者中. 口服抗凝药 (OAC) 与TAVR后更高的重大出血率有关.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成研究研究
背景情况:
- 最佳的抗血小板/抗血小板治疗转管术后的大动脉置换 (TAVR) 缺乏可靠的数据.
- 目前指导TAVR后抗血栓策略的证据有限.
研究的目的:
- 基于抗血小板治疗 (双抗血小板[DAPT]与单抗血小板[SAPT]) 和口服抗凝剂 (OAC) 使用的TAVR患者的缺血和出血结果进行比较.
- 评估TAVR后不同抗血栓治疗方案的安全性和有效性.
主要方法:
- 492名TAVR患者 (2012-2020年) 的回顾性分析.
- 使用发病率,卡普兰-梅尔和考克斯比例危险分析对缺血和出血结果的比较.
- 基于DAPT,SAPT和OAC使用的结果分层.
主要成果:
- 双抗血小板治疗 (DAPT) 与单抗血小板治疗 (SAPT) 相比,与1年死亡或缺血的发生率更高有关,特别是在没有冠状动脉疾病 (CAD) 的患者中.
- 口服抗凝剂 (OAC) 的使用显著增加了严重出血的风险,特别是晚出血 (>1年后TAVR).
- 多变量分析确定DAPT是死亡或缺血的独立预测因子,OAC是主要出血的独立预测因子.
结论:
- 在TAVR后的常规DAPT可能会带来伤害信号,增加死亡或缺血的风险.
- 随着OAC的晚出血发生率增加,建议在TAVR后探索替代性抗血栓策略.
- 需要进一步的研究来确定TAVR后的最佳抗血栓治疗.
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