Jurriën ten Berg, MD, PhD, FESC, FACC, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands, Tel.: +31 30 6099111, Fax: +31 30 6092274, E-mail:
Thromb Haemost. 2015 Apr;113(4):674-85. doi: 10.1160/TH14-10-0821. Epub 2015 Feb 5.
Transcatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valvular disease who are not suitable for conventional surgical aortic valve replacement. Despite improving experience and techniques, ischaemic and bleeding complications after TAVI remain prevalent and impair survival in this generally old and comorbid-rich population. Due to changing aetiology of complications over time, antiplatelet and anticoagulant therapy after TAVI should be carefully balanced. Empirically, a dual antiplatelet strategy is generally used after TAVI for patients without an indication for oral anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve prosthesis), including aspirin and a thienopyridine. For patients on OAC, a combination of OAC and aspirin or thienopyridine is generally used. This review shows that current registries are unfit to directly compare antithrombotic regimens. Small exploring studies suggest that additional clopidogrel after TAVI only affects bleeding and not ischemic complications. However, these studies are lack in quality in terms of Cochrane criteria. Currently, three randomised controlled trials are recruiting to gather more knowledge about the effects of clopidogrel after TAVI.
经导管主动脉瓣植入术（TAVI）是一种成熟的治疗方法，适用于不适合传统外科主动脉瓣置换的严重主动脉瓣疾病有症状的患者。尽管经验和技术不断提高，但 TAVI 后的缺血和出血并发症仍然普遍存在，并损害了这一通常高龄且合并症丰富的人群的生存率。由于并发症的病因随时间而变化，TAVI 后抗血小板和抗凝治疗应仔细平衡。根据经验，对于没有口服抗凝治疗（OAC；例如，心房颤动、机械二尖瓣假体）指征的 TAVI 患者，一般使用双重抗血小板策略，包括阿司匹林和噻吩吡啶。对于正在接受 OAC 治疗的患者，一般使用 OAC 和阿司匹林或噻吩吡啶联合治疗。这篇综述表明，目前的登记处不适合直接比较抗血栓形成方案。小型探索性研究表明，TAVI 后加用氯吡格雷仅影响出血而不影响缺血性并发症。然而，这些研究在 Cochrane 标准方面质量不足。目前，有三项随机对照试验正在招募参与者，以收集更多关于 TAVI 后氯吡格雷作用的知识。
