维生素K对抗剂与透气导管中枢替换后的直接口服抗凝药
Maja Wichhart Donzo1, Elsa Hebbo1, Hiroki A Ueyama1
1Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia.
The American journal of cardiology
|July 19, 2025
概括
经过透气管 mitra 置换术 (TMVR) 后的最佳抗凝剂在维生素K 抗剂 (VKA) 和直接口服抗凝剂 (DOAC) 之间没有显著差异. 需要进一步的随机试验,以提供关于TMVR抗凝策略的最终指导.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 抗凝固疗法 抗凝固疗法
背景情况:
- 没有确立最佳的抗凝血方法 - - 透气管后的额头置换 (TMVR).
- 目前在TMVR后进行抗凝血的做法缺乏标准化.
- 对于TMVR抗凝策略,没有随机试验数据.
研究的目的:
- 为了比较维生素K对抗剂 (VKA) 和直接口服抗凝剂 (DOAC) 在TMVR后的临床结果.
- 评估TMVR后不同抗凝方法的安全性和有效性.
- 为了评估患者的门血液动力学VKA对比DOAC后TMVR.
主要方法:
- 在2012-2022年间对148名接受了门内 (ViV) 或门内环 (ViR) TMVR的患者进行了回顾性分析.
- 在VKA和DOAC组之间比较临床结果和膜血液动力学.
- 主要结局:主要不良心血管事件 (MACE),包括全因死亡,中风或膜血栓形成.
主要成果:
- 在VKA和DOAC组之间的1年无MACE生存时间没有显著差异 (p=0.68).
- 无论是VKA还是DOAC都有效地降低了TMVR后的中枢平均梯度,在1年后得到了持续的结果.
- 在VKA组中,共发病的患病率较高,如心肌梗塞和心房动.
结论:
- 用DOAC或VKA进行的抗凝血疗法在TMVR后显示出可比的临床结果.
- 这两种抗凝血策略都为TMVR后的额头提供了类似的血液动力学益处.
- 需要进行更大规模的随机临床试验来证实这些发现,并指导TMVR后的最佳抗凝血治疗.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.3K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.3K
Venous Thrombosis III: Interprofessional Care
23
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
23
Anticoagulant Drugs: Low-Molecular-Weight Heparins
913
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
913
Mitral Stenosis III: Medical Management
27
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
27
Mitral Regurgitation III: Medical Management
34
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
34
Mitral Valve Prolapse II: Assessment and Management
43
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular...
43


