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超导管后大动脉置换非指标患者的抗血栓治疗:更新的系统性审查和网络元分析

Sahand Siami¹, Sina Kazemian², Saba Maleki²

¹Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran.

|April 26, 2025

概括

单一抗血小板治疗 (SAPT) 是在不需要抗凝血治疗的患者中,在过导管大动脉置换 (TAVR) 后最安全的抗血小板治疗策略. 与其他疗法相比,SAPT可以降低出血风险,但不会影响疗效.

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是通过透气管后的大动脉置换 (TAVR) 进行辩论.
接受TAVR治疗的患者往往缺乏慢性抗凝药的明确指示.

研究的目的:

评估TAVR后不同抗血栓策略的安全性和有效性.
专注于没有注射口服抗凝药的患者.

主要方法:

在主要数据库 (PubMed,Embase,Scopus,ClinicalTrials.gov) 的系统文献搜索.
网络元分析比较单抗血小板治疗 (SAPT),双抗血小板治疗 (DAPT),口服抗凝剂 (OAC) 和OAC + SAPT.
评估结果:全因死亡率,心血管死亡率,心肌梗塞,中风和出血事件.

主要成果:

与DAPT,OAC和OAC+SAPT相比,SAPT显著降低了危及生命/严重出血的风险.
在治疗方案之间,心血管死亡率,中风或心肌梗塞没有显著差异.
低剂量里瓦罗克萨班加SAPT与死亡率增加有关;COPD被确定为出血风险修饰因素.

结论:

这些发现支持当前的指导方针,这些指导方针有利于在没有抗凝血指示的患者中接受SAPT后TAVR.
在这种患者群体中,SAPT提供了最佳的安全性和有效性.

关键词:

这是一种直接的口服抗凝剂.双重抗血小板疗法双重抗血小板疗法低剂量里瓦洛克萨班一次性抗血小板治疗.通过导管更换大动脉门.维生素K的对抗者.

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