Mydin Muhammad I, Dimitrakakis Georgios, Younis Jenan, Nowell Justin, Athanasiou Thanos, Kourliouros Antonios
Department of Cardiac Surgery, St Thomas' Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):109-14. doi: 10.1093/icvts/ivs102. Epub 2012 Apr 5.
Optimal thromboprophylaxis following bioprosthetic aortic valve replacement (AVR) remains controversial. The main objective, which is the effective prevention of central nervous or peripheral embolic events, especially in the early postoperative period, will have to be weighed against the haemorrhagic risk that is associated with the utilization of different antithrombotic regimes. Most governing bodies in cardiovascular medicine have issued recommendations on thromboprophylaxis after the surgical implantation of aortic bioprostheses. However, the level of evidence to support these recommendations remains low, largely due to the inherent limitations of conducting appropriately randomized and adequately powered clinical research in this area. It is apparent from the recent surveys and large registries that there is a great variability in antithrombotic practice at an institutional or individual-clinician level reflecting this controversy and the lack of robust evidence. While organizational, financial or conceptual limitations could hinder the conduct and availability of conclusive research on optimal thromboprophylaxis after aortic bioprosthesis, it is imperative that all evidence is presented in a systematic way in order to assist the decision-making for the modern clinician. In this review, we provide an outline of the current recommendations for thromboprophylaxis, followed by a comprehensive and analytical presentation of all comparative studies examining anticoagulation vs. antiplatelet therapy after bioprosthetic AVR.
生物人工心脏主动脉瓣置换术（AVR）后的最佳血栓预防措施仍存在争议。主要目标是有效预防中枢神经系统或外周栓塞事件，尤其是在术后早期，这一目标必须与使用不同抗血栓治疗方案所带来的出血风险相权衡。大多数心血管医学管理机构已发布关于主动脉生物人工瓣膜手术植入后血栓预防的建议。然而，支持这些建议的证据水平仍然较低，这主要是由于在该领域进行适当随机且样本量充足的临床研究存在固有局限性。从最近的调查和大型登记研究中可以明显看出，在机构或个体临床医生层面，抗血栓治疗实践存在很大差异，这反映了这一争议以及缺乏有力证据的情况。虽然组织、财务或概念上的限制可能会阻碍关于主动脉生物人工瓣膜置换术后最佳血栓预防的确凿研究的开展和获取，但必须以系统的方式呈现所有证据，以帮助现代临床医生进行决策。在本综述中，我们概述了当前的血栓预防建议，随后对所有比较生物人工心脏主动脉瓣置换术后抗凝治疗与抗血小板治疗的对照研究进行全面分析介绍。
