膜血栓形成和生物假体中替换后的抗血栓治疗:系统性审查和元分析
Mark J Zorman1,2, Jonathan Vibhishanan1, Katerina Dangas1
1Oxford Heart Centre, Oxford University Hospitals NHS Trust, Headley Way, Oxford, OX3 9DU, UK.
European heart journal. Cardiovascular pharmacotherapy
|February 4, 2025
概括
在手术后的患者中,5.05%发生生物假体膜血栓形成 (bMVT). 与直接口服抗凝剂相比,维生素K对手的bMVT发病率较低.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 生物材料科学 生物材料科学
背景情况:
- 过导管 mitra 置换 (TMVR) 是高风险患者手术 mitra 置换 (SMVR) 的替代方案.
- 在TMVR和SMVR后,膜血栓形成的风险和最佳的抗血栓治疗仍然不清楚.
研究的目的:
- 为了比较SMVR和TMVR后生物假体中栓塞 (bMVT) 的发生率.
- 评估不同抗血栓治疗方案的患者中bMVT的发生率.
主要方法:
- 在Medline,Embase和Cochrane图书馆 (2000年1月至2024年8月) 进行了全面的文献搜索.
- 使用随机效应模型来估计bMVT的聚合发病率.
- 包括47项研究,包括6170名患者和9541.8名患者的随访年.
主要成果:
- 总体bMVT的发生率为每100个患者年5.05.
- 亚临床bMVT明显比临床显著的bMVT更常见 (19.11对比7.91每100个患者年).
- 服用维生素K对抗剂 (VKA) 的患者与服用直接口服抗凝剂 (DOAC) 的患者相比,bMVT的发病率较低 (5.72对17.08每100个患者年).
结论:
- 生物假体中关血栓是一种显著的并发症,在TMVR后的发病率比SMVR更高,尽管在统计学上并不显著.
- 与直接口服抗凝剂相比,维生素K 抗剂与bMVT的发病率降低有关.
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