连续与中断的口服抗凝剂在跨导管大动脉植入期间:一个系统的审查和元分析
Farhan Naeem1, Shehroze Tabassum2, Mohamed Saad Rakab3
1From the Department of Cardiology, Massachusetts General Hospital, Boston, MA.
Cardiology in review
|August 1, 2025
概括
继续口服抗凝药 (OAC) 或在过导管大动脉植入前 (TAVI) 中断,显示出类似的安全性和有效性. 持续的OAC稍微增加了轻微出血事件,但没有影响重大并发症或死亡率.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 抗凝血管理 抗凝血管理
背景情况:
- 缺乏证据和指南建议,用于术前口服抗凝剂 (OAC) 管理在透气管大动脉植入 (TAVI).
- 需要对TAVI程序的持续OAC (cOAC) 与中断OAC (iOAC) 策略进行比较.
研究的目的:
- 为了比较持续口服抗凝剂 (cOAC) 与中断口服抗凝剂 (iOAC) 的安全性和有效性,在接受过导管大动脉植入 (TAVI) 的患者中.
主要方法:
- 在PubMed,Embase,Cochrane Central和ClinicalTrials.gov.gov.的综合文献搜索.
- 用随机效应模型对4项涉及3117名患者的研究进行元分析.
- 对早期安全结果,缺血事件,出血并发症,死亡率和住院时间的分析.
主要成果:
- 在30天的安全结果,复合性缺血事件,严重出血或危及生命的出血中,cOAC和iOAC之间没有显著差异.
- cOAC与轻微出血事件的发生率略高相关 (OR: 1.40,95% CI: 1.02-1.93,P = 0.04).
- 观察到主要血管并发症,全因死亡率,心脏死亡率,中风,TIA,MI和住院的比较率.
结论:
- 持续口服抗凝剂 (cOAC) 和中断口服抗凝剂 (iOAC) 两种策略在接受过导管大动脉植入 (TAVI) 的患者中都显示出可比的安全性和有效性.
- 在COAC和IOAC之间做出选择时,可以考虑COAC带来的轻微出血风险略有增加.
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