在TAVI期间继续或中断口服抗凝药
Dirk Jan van Ginkel1, Willem L Bor1, Hugo M Aarts1
1From the Department of Cardiology, St. Antonius Hospital, Nieuwegein (D.J.G., W.L.B., J.P., B.J.W.M.R., L.T., M.J.S., J.B., V.J.N., D.C.O., J.M.B.), the Department of Cardiology, Amsterdam UMC, Amsterdam (H.M.A., J.G.P.T., R.D.), the Department of Cardiology, University Medical Center Utrecht, Utrecht (H.M.A., M. Voskuil), the Department of Cardiology, Radboud University Medical Center, Nijmegen (M.J.P.R., V.J.N., N.R.), the Department of Cardiology, Maastricht University Medical Center (L.V., A.J.J.I., P.A.V., A.W.J.H.), and Cardiovascular Research Institute Maastricht (L.V., P.A.V., A.W.J.H., J.M.B.), Maastricht, the Department of Cardiology, Leiden University Medical Center, Leiden (F.K., J.M.M.-C.), the Department of Cardiology, University Medical Center Groningen, Groningen (K.H.B., J.J.W.), the Department of Cardiology, Erasmus University Medical Center, Rotterdam (N.M.V.M.), the Department of Cardiology, Haga Hospital, the Hague (C.E.S.), the Department of Cardiology, Amphia Hospital, Breda (A.J.J.I., J.H., B.J.L.V.B.), the Department of Cardiology, Isala Hospital, Zwolle (R.S.H., R.L.), and the Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg (J.H.) - all in the Netherlands; the Department of Cardiovascular Medicine, University Hospital Leuven, Leuven (C.D., T.A.), the Department of Cardiology, Algemeen Stedelijk Hospital Aalst (L.R.), and Cardiovascular Center Aalst, Onze Lieve Vrouw Hospital (E.B., M. Vanderheyden), Aalst, the Department of Cardiology, Hospital Network Antwerp (ZNA) Middelheim, Antwerp (P.A., H.E.J.), the Department of Cardiology, Sint-Jan Hospital, Bruges (J.A.S.V.D.H.), the Department of Cardiology, AZ Delta, Roeselare (K.D.), and the Department of Cardiology, Hospital Oost-Limburg, Genk (B.F.) - all in Belgium; the Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen (O.D.B., Y.K.); the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Cardiothoracovascular Department, University of Trieste, Trieste (E.F.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); and the Department of Cardiology, Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg (P.F., M.L.).
在跨导管大动脉植入 (TAVI) 期间继续服用口服抗凝剂并未被发现与中断无差. 在接受TAVI的抗凝固治疗的患者中,中断可能会降低出血风险,而不会增加血栓栓塞事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 抗凝疗法是一种抗凝疗法.
背景情况:
- 由于伴随疾病,经过过导管大动脉植入 (TAVI) 的大量患者需要口服抗凝剂.
- 在这些患者中,在TAVI期间平衡出血与血栓栓塞的风险是一个关键的临床挑战.
研究的目的:
- 评估是否继续口服抗凝药与在TAVI期间中断其无劣.
- 评估抗凝管理对TAVI后30天内关键临床结果的影响.
主要方法:
- 进行了一项国际性的,开放的,随机的,非劣等性试验.
- 接受口服抗凝剂和接受TAVI的858名患者被随机分为1:1继续或中断抗凝治疗.
- 主要结局是心血管死亡,中风,心肌梗塞,主要血管并发症或30天后严重出血的组合.
主要成果:
- 主要综合结局发生在继续组的16.5%,而中断组的14.8% (P=0.18为非劣势).
- 血栓塞栓事件在各组之间是相似的 (8.8%对8.2%).
- 与中断组 (21.3%) 相比,继续组 (31.1%) 的重大出血发生的频率明显高.
结论:
- 在接受TAVI的患者中,口服抗凝药的周围程序延续并非低于中断的主要复合结局.
- 暂停口服抗凝药可能是一个更安全的策略,显示较低的大型出血率,而不会增加血栓栓塞事件.
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