Department of Cardiovascular Medicine, University of Leuven, Belgium.
Cardiol Rev. 2013 Jan-Feb;21(1):27-36. doi: 10.1097/CRD.0b013e3182638578.
Heart valve prostheses carry a risk for thrombosis and require an antithrombotic strategy to prevent stroke, systemic embolism, and prosthetic valve thrombosis. Contemporary randomized trials to guide the clinician on the optimal anticoagulant treatment are scarce, and the validity of the historical data for current recommendations can be questioned in view of the changes in valve prostheses, the patient population, and antithrombotic therapies. This limited evidence from clinical trials translates into divergent recommendations from the different scientific societies on the optimal intensity of oral anticoagulation and on the indication for antiplatelet therapy. The availability of new antithrombotic agents and the unclear thrombotic risk of the currently used prostheses underscore the need to redefine antithrombotic treatment in patients with heart valve prostheses.
心脏瓣膜假体存在血栓形成的风险，需要采取抗血栓策略来预防中风、全身性栓塞和人工心脏瓣膜血栓形成。目前指导临床医生选择最佳抗凝治疗的当代随机试验很少，鉴于瓣膜假体、患者人群和抗血栓治疗的变化，历史数据对当前建议的有效性可能受到质疑。临床试验中的这一有限证据导致不同科学协会对口服抗凝的最佳强度以及抗血小板治疗的适应证的建议存在差异。新型抗血栓药物的出现以及目前使用的假体的血栓形成风险不明确，这突显了需要重新定义心脏瓣膜假体患者的抗血栓治疗。
