Gurevich Sergey, Oestreich Brett, Kelly Rosemary F, Mbai Mackenzie, Bertog Stefan, Yannopoulos Demetris, Garcia Santiago
University of Minnesota Fairview Medical Center, Minneapolis, MN, United States.
Minneapolis VA Healthcare System, Minneapolis, MN, United States.
Cardiovasc Revasc Med. 2018 Jul-Aug;19(5 Pt B):621-625. doi: 10.1016/j.carrev.2017.12.001. Epub 2017 Dec 6.
Subclinical leaflet thrombosis (SCLT) can be seen in up to 12% of patients after transcatheter aortic valve replacement (TAVR). Anticoagulation appears to prevent and reverse SCLT but concerns exist about bleeding risk.
Our program adopted a strategy of routine anticoagulation after TAVR, starting warfarin on post-procedure day 0 and continuing for 3months in 10/2015. We report the initial safety and efficacy outcomes of this approach. Bleeding events were assessed using Valve Academic Research Consortium (VARC) and Bleeding Academic Research Consortium (BARC) definitions.
The median (IQR) age of the population (n=191) was 82years (72-87) and the median (IQR) STS score was 5.6% (3-8). A total of 101 (53%) patients were discharged on anticoagulation (warfarin 97%) while 90 (47%) received antiplatelet therapy alone. The mean duration of anticoagulation therapy was 81±17 days. During follow-up 7 patients (4%) had a stroke or TIA, 3 (3%) in the anticoagulation group and 4 (4%) in the antiplatelet group (p=0.71). A total of 8 patients (4.2%) had BARC bleeding events during follow-up, 3 patients in the anticoagulation group (2.9%) and 5 in the antiplatelet group (5.5%, p=0.48). All bleeding events (VARC and BARC) were numerically lower in the anticoagulation group (8% versus 13%, p=0.20).
A strategy of routine anticoagulation for 3-months after TAVR is well tolerated and associated with similar or lower bleeding risk compared to antiplatelet therapy.
在经导管主动脉瓣置换术（TAVR）后，高达12%的患者可出现亚临床瓣叶血栓形成（SCLT）。抗凝似乎可预防和逆转SCLT，但存在出血风险方面的担忧。
我们的项目采用了TAVR后常规抗凝策略，于2015年10月在术后第0天开始使用华法林，并持续3个月。我们报告了该方法的初步安全性和有效性结果。使用瓣膜学术研究联盟（VARC）和出血学术研究联盟（BARC）的定义评估出血事件。
研究人群（n = 191）的年龄中位数（IQR）为82岁（72 - 87岁），STS评分中位数（IQR）为5.6%（3 - 8）。共有101例（53%）患者出院时接受抗凝治疗（97%使用华法林），而90例（47%）患者仅接受抗血小板治疗。抗凝治疗的平均持续时间为81±17天。随访期间，7例（4%）患者发生中风或短暂性脑缺血发作（TIA），抗凝组3例（3%），抗血小板组4例（4%）（p = 0.71）。随访期间共有8例（4.2%）患者发生BARC出血事件，抗凝组3例（2.9%），抗血小板组5例（5.5%，p = 0.48）。抗凝组的所有出血事件（VARC和BARC）在数量上均较低（8%对13%，p = 0.20）。
TAVR后进行3个月常规抗凝的策略耐受性良好，与抗血小板治疗相比，出血风险相似或更低。
