Mangieri Antonio, Jabbour Richard J, Montalto Claudio, Pagnesi Matteo, Regazzoli Damiano, Ancona Marco B, Giannini Francesco, Tanaka Akihito, Bertoldi Letizia, Monaco Fabrizio, Agricola Eustachio, Giglio Manuela, Mattioli Roberto, Ferri Luca, Montorfano Matteo, Chieffo Alaide, Alfieri Ottavio, Colombo Antonio, Latib Azeem
Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy.
Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy.
Am J Cardiol. 2017 Apr 1;119(7):1088-1093. doi: 10.1016/j.amjcard.2016.11.065. Epub 2017 Jan 6.
There is limited evidence to support decision-making regarding discharge antiplatelet therapy after transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the outcome of patients discharged on single-antiplatelet therapy (SAPT) or dual-antiplatelet therapy (DAPT) after TAVI. Consecutive patients were identified by retrospective review of a dedicated TAVI database of a single high-volume center in Milan, Italy, from January 2009 to May 2015. Our primary end point was the rate of net adverse clinical events defined as a composite of all-cause mortality, major bleeding requiring hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic valve replacement, and valve thrombosis. A total of 439 patients were included in the final analysis; 108 patients were discharged on SAPT and 331 on DAPT. Reasons for discharge SAPT included high risk of bleeding (n = 33; 31%), postprocedural bleeding (n = 42; 39%), thrombocytopenia (n = 20; 18%), vascular complications (n = 13; 12%). The mean length of DAPT was 5.2 ± 2.7 months. Patients discharged in SAPT had a higher incidence of life-threatening bleeding during the index hospitalization. At follow-up, no differences were observed in the incidence of net adverse clinical event, all-cause or cardiovascular mortality, and cerebrovascular events. A similar rate of valve thrombosis was reported in both groups. In conclusion, prescribing only SAPT after TAVI in selected patients was not associated with an increased risk of events and may be an acceptable alternative to DAPT in elderly patients at high risk of bleeding.
关于经导管主动脉瓣植入术（TAVI）后出院抗血小板治疗的决策，支持证据有限。本研究的目的是评估TAVI术后接受单药抗血小板治疗（SAPT）或双联抗血小板治疗（DAPT）出院患者的结局。通过回顾性分析意大利米兰一家高容量中心2009年1月至2015年5月专门的TAVI数据库，确定连续纳入的患者。我们的主要终点是净不良临床事件发生率，其定义为全因死亡率、需要住院治疗的大出血、脑血管意外、再次TAVI或外科主动脉瓣置换术以及瓣膜血栓形成的综合指标。最终分析共纳入439例患者；108例患者接受SAPT出院，331例接受DAPT出院。出院接受SAPT的原因包括出血风险高（n = 33；31%）、术后出血（n = 42；39%）、血小板减少（n = 20；18%）、血管并发症（n = 13；12%）。DAPT的平均疗程为5.2±2.7个月。接受SAPT出院的患者在索引住院期间发生危及生命出血的发生率更高。在随访中，净不良临床事件、全因或心血管死亡率以及脑血管事件的发生率未观察到差异。两组报告的瓣膜血栓形成发生率相似。总之，在选定患者中TAVI术后仅开具SAPT与事件风险增加无关，对于出血风险高的老年患者可能是DAPT的可接受替代方案。
