在接受TAVR的患者中,肝素剂量,体重指数和中风风险之间的关联
Ziad Arow1,2, Juri Iwata1, Akiko Masumoto1
1Groupe Cardio Vasculaire Interventionnel, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.
Journal of clinical medicine
|February 13, 2026
概括
在这项研究中,未分离的氨酸 (UFH) 剂量和在跨导管大动脉置换 (TAVR) 期间的激活凝血时间 (ACT) 水平没有显著影响中风风险或程序结果. 需要进行进一步的随机试验,以确定TAVR患者的最佳抗凝策略.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 麻醉学 麻醉学
背景情况:
- 未分离的氨酸 (UFH) 是通过导管的大动脉置换 (TAVR) 期间预防血栓的标准.
- 对TAVR的最佳UFH剂量和目标激活凝血时间 (ACT) 值仍然未被基于证据的指南定义.
- 这项研究调查了TAVR患者的UFH,ACT和中风风险,按体重指数 (BMI) 分层.
研究的目的:
- 评估TAVR患者的手术内UFH剂量,ACT和手术前中风风险之间的关系.
- 分析基于BMI (<30对≥30 kg/m2) 的中风风险.
- 评估二次结果,包括程序参数,死亡率和安全性.
主要方法:
- 分析了一组由1045名接受TAVR治疗严重大动脉狭窄症的患者组成的队列.
- 患有心房或接受慢性抗凝药的患者被排除在外.
- 脑卒中发生率,手术数据和1年死亡率是主要和次要结局,根据BMI和ACT值进行亚组分析.
主要成果:
- 平均肝素剂量为47U/kg,平均ACT为218s;较低的BMI患者接受了更高的剂量,并且具有更高的ACT.
- 在手术前的中风率很低 (1.1%),在BMI组中相似 (1.2%对0.9%).
- 根据ACT值 (≤250 vs. >250s),以及1年死亡率或安全性结果,没有观察到中风发生率的显著差异.
结论:
- 在这个队列中,UFH剂量和ACT的变化与手术前中风或TAVR的整体结果没有相关性.
- 低事件率需要谨慎地解释这些发现.
- 预期随机试验对于确定TAVR的最佳抗凝策略至关重要.
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