Poliacikova Petra, Cockburn James, de Belder Adam, Trivedi Uday, Hildick-Smith David
Sussex Cardiac Centre, Eastern Road, BN2 5BE, Brighton, United Kingdom.
J Invasive Cardiol. 2013 Oct;25(10):544-8.
We compared procedural and follow-up complications of TAVI patients based on the type of antithrombotic treatment used (single-antiplatelet [SAPT] vs dual-antiplatelet [DAPT] vs warfarin).
Despite growing operator experience and device development, vascular complications following transcatheter aortic valve implantation (TAVI) remain problematic. Bleeding complications and stroke are two of the main disadvantages compared with surgical aortic valve replacement. Correct choice of antiplatelet or antithrombotic treatment is therefore crucial, but remains empirical.
We analyzed a cohort of 171 patients with symptomatic severe aortic stenosis who underwent TAVI using the CoreValve (Medtronic, Inc) in our center between December 2007 and June 2012. We assessed both procedural, in-hospital, and follow-up outcomes for vascular complications, stroke, myocardial infarction, bleeding complications, and death.
Patients were aged 81.6 ± 6.4 years; 47% were male. Treatment regimes were DAPT (34%), SAPT (53%), or warfarin (13%). When analyzing the combined endpoint of all-cause death, acute coronary events, stroke, or bleeding, the outcome was significantly worse in the DAPT group (in-hospital P=.01, 30-day follow-up P=.02). This difference was driven mainly by bleeding complications, with a trend toward higher rates of major bleeding events in the DAPT group vs SAPT group (P=.07 for both in-hospital and 30-day bleeding). The occurrence of major adverse cardiac and cerebrovascular events was statistically similar in all groups.
This relatively small series suggests that DAPT does not protect patients from stroke, but may expose them to higher bleeding risk. Further study of this area is warranted.
我们根据所使用的抗血栓治疗类型（单药抗血小板治疗[SAPT]对比双联抗血小板治疗[DAPT]对比华法林），比较经导管主动脉瓣植入术（TAVI）患者的手术及随访并发症情况。
尽管术者经验不断增加且器械不断发展，但经导管主动脉瓣植入术（TAVI）后的血管并发症仍然是个问题。与外科主动脉瓣置换术相比，出血并发症和中风是两个主要缺点。因此，正确选择抗血小板或抗血栓治疗至关重要，但仍属经验性选择。
我们分析了2007年12月至2012年6月间在我们中心接受使用美敦力公司CoreValve进行TAVI的171例有症状的严重主动脉瓣狭窄患者队列。我们评估了血管并发症、中风、心肌梗死、出血并发症和死亡的手术、住院及随访结果。
患者年龄为81.6±6.4岁；47%为男性。治疗方案为DAPT（34%）、SAPT（53%）或华法林（13%）。在分析全因死亡、急性冠脉事件、中风或出血的联合终点时，DAPT组的结果明显更差（住院时P = 0.01，30天随访时P = 0.02）。这种差异主要由出血并发症导致，DAPT组的大出血事件发生率有高于SAPT组的趋势（住院和30天出血时P均为0.07）。所有组中主要不良心脑血管事件的发生率在统计学上相似。
这个相对较小的系列研究表明，DAPT并不能保护患者免于中风，但可能使他们面临更高的出血风险。该领域值得进一步研究。
