The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Semin Thromb Hemost. 2018 Feb;44(1):38-45. doi: 10.1055/s-0037-1607457. Epub 2018 Jan 5.
Transcatheter heart valve replacement technology was introduced as alternative to surgery for the growing high-risk profile population. Developed first, aortic valve replacement (TAVR) became a standard of care for patients with severe aortic stenosis at high operative risk, with a potential future use also for low-risk subjects. In the last decade, a multitude of transcatheter mitral valve replacement (TMVR) devices have been developed for the treatment of severe mitral regurgitation, with encouraging results coming from first-in-man and feasibility studies. As for biological surgical-type valves, transcatheter implanted valves still preserve the risk of thrombosis and embolic events and anticoagulation- or antiplatelet-based strategies are the most widely used options. Unfortunately, these last remain recommended on the basis of empirical or not widely validated evidence. Therefore, given the exponential rise of TAVR and TMVR procedures, it is important to identify the optimal antithrombotic strategies that best fit the risk of thromboembolic and bleeding events. Hereafter, this review evaluates the current guidelines, trials, and observational data discussing antithrombotic strategy after transcatheter aortic or mitral valve replacement.
经导管心脏瓣膜置换技术被引入，作为手术治疗高危人群的替代方法。首先开发的主动脉瓣置换术（TAVR）成为高危手术风险严重主动脉瓣狭窄患者的治疗标准，未来也可能用于低危患者。在过去十年中，已经开发出多种经导管二尖瓣置换术（TMVR）装置来治疗严重二尖瓣反流，来自首例人体和可行性研究的结果令人鼓舞。与生物手术型瓣膜一样，经导管植入的瓣膜仍然存在血栓和栓塞事件的风险，抗凝或抗血小板治疗策略是最广泛使用的选择。不幸的是，这些治疗方法仍然是基于经验或未广泛验证的证据而推荐的。因此，鉴于 TAVR 和 TMVR 手术的指数级增长，确定最适合血栓栓塞和出血事件风险的最佳抗血栓形成策略非常重要。此后，本综述评估了当前的指南、试验和观察性数据，讨论了经导管主动脉瓣或二尖瓣置换术后的抗血栓形成策略。
