通过导管大动脉植入后的血栓与出血风险相比.
Kotsi Sofia Fotoula1, Abdalazeem Ibrahem1,2, Allam Harfoush1,3
1Cardiology Department, North Bristol NHS Trust, Bristol BS10 5NB, UK.
Journal of clinical medicine
|March 14, 2026
概括
通过导管大动脉植入术 (TAVI) 后的最佳抗血栓治疗平衡出血和凝血风险. 目前的证据支持单一抗血小板治疗或单独口服抗凝药,根据患者的指示,避免在未经选择的患者中进行常规使用.
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:
- 跨导管大动脉植入 (TAVI) 的使用在所有风险群体中都在增加,导致更多的长期患者使用生物假体.
- 这些患者往往是多病症,增加了对血栓和出血并发症的脆弱性.
- 由于试验设计和患者人群的多样化,TAVI后最佳抗血栓治疗仍然不清楚.
研究的目的:
- 根据TAVI,审查有关抗血栓策略的现有证据.
- 评估抗血小板和抗凝固疗法,出血/血栓预测因素,以及新兴的个性化风险分层方法.
- 提供关于TAVI后最佳抗血栓剂管理的指导.
主要方法:
- 随机对照试验,观察性研究,生物标志物研究和指导方针的叙述性综述.
- 对抗血小板和抗凝固剂策略的证据评估.
- 对出血和血栓性并发症的预测因素的分析.
主要成果:
- 血栓事件主要是早期和程序性的;新的心房动 (AF) 增加了晚期风险.
- 亚临床传单血栓形成是常见的,但其临床影响和抗凝剂的益处是不确定的.
- 早期出血是主要的死亡因素;简约的,以指示为导向的疗法 (单抗血小板或OAC单疗法) 得到证据的支持.
结论:
- 在TAVI后的抗血栓策略必须平衡出血最小化与血栓塞栓性保护.
- 单一的抗血小板治疗 (没有OAC指示) 或单独的OAC (与AF) 提供了最佳的安全性/有效性.
- 未来的策略可能涉及成像,生物标志物和机器学习,以进行个性化风险评估.
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