Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Clin Res Cardiol. 2018 Sep;107(9):799-806. doi: 10.1007/s00392-018-1247-x. Epub 2018 Apr 11.
Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI.
Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy. Thromboembolic as well as bleeding complications were analysed for 6 months after TAVI.
Despite high CHADS-Vasc (4.6 ± 1.2), HEMORRHAGES (4.7 ± 1.9) and HASBLED (2.7 ± 0.8) scores only three major/life-threatening bleedings and four thromboembolic events occurred after NOAC therapy had been initiated post-TAVI. 12 patients (7.8%) died within 6 months after the procedure. Compared to patients being treated with VKA monotherapy, analysis of a combined end-point of post-procedural death, stroke, embolism and severe bleeding revealed no significant differences (17/154 vs. 14/172; p = 0.45).
The results of this study suggest that NOAC therapy without additional antiplatelet treatment is effective and safe in patients with concomitant indications for OAC undergoing TAVI.
经导管主动脉瓣置换术（TAVI）后抗血栓治疗存在很大争议，指南推荐意见也没有循证医学证据。我们评估了同时存在口服抗凝剂（OAC）适应证的 TAVI 患者接受非维生素 K 拮抗剂口服抗凝剂（NOAC）单药治疗的疗效和安全性。
在 2008 年以来的 1300 多名 TAVI 患者中，确定了 154 名接受介入后 NOAC 单药治疗的患者。将这些患者的结果与 172 名接受维生素 K 拮抗剂（VKA）单药治疗的患者进行了比较。对 TAVI 后 6 个月内的血栓栓塞和出血并发症进行了分析。
尽管 CHADS-Vasc（4.6±1.2）、HEMORRHAGES（4.7±1.9）和 HASBLED（2.7±0.8）评分较高，但在开始 TAVI 后接受 NOAC 治疗后，仅发生了 3 例重大/危及生命的出血和 4 例血栓栓塞事件。12 名患者（7.8%）在术后 6 个月内死亡。与接受 VKA 单药治疗的患者相比，对术后死亡、中风、栓塞和严重出血的联合终点进行分析，结果无显著差异（17/154 例 vs. 14/172 例；p=0.45）。
这项研究的结果表明，对于同时存在 OAC 适应证的 TAVI 患者，不联合抗血小板治疗的 NOAC 治疗是有效和安全的。
