Interventional Cardiology Unit, S. Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
Am J Cardiol. 2013 Jan 15;111(2):237-42. doi: 10.1016/j.amjcard.2012.09.023. Epub 2012 Oct 27.
Patients who undergo transcatheter aortic valve implantation are generally discharged on dual-antiplatelet therapy. However, many of these patients also have indications for anticoagulant therapy, and it is unclear what the best antithrombotic strategy is in these cases. Data from 360 patients who underwent transcatheter aortic valve implantation were retrospectively analyzed, of whom 60 (16.7%) had indications for anticoagulant treatment, mainly because of atrial fibrillation. The antithrombotic regimen was decided according to clinical evaluation of thrombotic and hemorrhagic risk; most of these patients (n = 43) were discharged with warfarin plus a single antiplatelet drug. Their outcomes were compared to those in a group with no indications for anticoagulation (n = 300) treated with dual-antiplatelet therapy. During the follow-up period (median 11 months), 53 patients (15%) died; mortality was not associated with antithrombotic regimen. The incidence of cerebral events or intracranial hemorrhage (4.6% and 1.1%, respectively) was low in the study population, and no significant differences were detected between groups; the bleeding rate was also unaffected by antithrombotic therapy. In conclusion, when anticoagulation is indicated after transcatheter aortic valve implantation, many variables must be taken into account. The most frequent scenario in this study was patients in atrial fibrillation, most of whom were discharged with warfarin plus a single antiplatelet medication. When bleeding was a concern, especially in the absence of coronary disease, warfarin alone was prescribed. These results suggest that this approach is safe, but data from larger, randomized studies are needed.
接受经导管主动脉瓣植入术的患者通常接受双联抗血小板治疗出院。然而，这些患者中有许多也有抗凝治疗的指征，目前尚不清楚在这些情况下最佳的抗血栓策略是什么。回顾性分析了 360 名接受经导管主动脉瓣植入术的患者的数据，其中 60 名（16.7%）有抗凝治疗指征，主要是因为心房颤动。抗血栓方案根据血栓形成和出血风险的临床评估决定；这些患者中的大多数（n=43）出院时服用华法林加单一抗血小板药物。他们的结果与接受双联抗血小板治疗且无抗凝指征的一组（n=300）进行比较。在随访期间（中位数 11 个月），53 名（15%）患者死亡；死亡率与抗血栓方案无关。研究人群中脑卒中和颅内出血的发生率较低（分别为 4.6%和 1.1%），两组间无显著差异；抗血栓治疗也不影响出血率。总之，经导管主动脉瓣植入术后需要抗凝治疗时，必须考虑许多因素。本研究中最常见的情况是心房颤动患者，其中大多数出院时服用华法林加单一抗血小板药物。当出血是一个关注点，特别是在没有冠心病的情况下，单独开华法林。这些结果表明这种方法是安全的，但需要更大规模、随机的研究数据。
