Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), 75013 Paris, France.
Service de Cardiologie, Hôpital Nord Laennec, CHU de Nantes, 44800 Saint-Herblain, France.
Arch Cardiovasc Dis. 2020 May;113(5):341-349. doi: 10.1016/j.acvd.2019.12.008. Epub 2020 Feb 27.
The effect of oral anticoagulation on clinical and haemodynamic outcomes following successful transcatheter aortic valve implantation is unclear.
To evaluate the effect of oral anticoagulation within the first year after transcatheter aortic valve implantation.
All patients undergoing transcatheter aortic valve implantation in two French tertiary centres from 2010 to 2016 were included prospectively. The composite outcome of death, stroke, readmission for heart failure or major/life-threatening bleeding according to Valve Academic Research Consortium 2 criteria within 1year was evaluated. Valvular haemodynamic deterioration was defined as mean transprosthetic gradient ≥20mmHg or an increase of ≥10mmHg during echocardiographic follow-up.
Of the 1139 patients included, 400 (35.1%) were discharged on oral anticoagulation. The primary endpoint was more frequent in the group with versus without oral anticoagulation (29.4% vs. 17.3% 21.5%; hazard ratio 1.83, 95% confidence interval 1.42-2.35). Composite endpoint risk factors were chronic pulmonary and kidney diseases, previous atrial fibrillation, left ventricular ejection fraction ≤30% at discharge and no femoral vascular approach, but not oral anticoagulation prescription at discharge. Conversely, 58 patients were identified with valvular haemodynamic deterioration, including 11 (19%) in the group with oral anticoagulation and 47 (81%) in the group without oral anticoagulation. Valvular haemodynamic deterioration risk factors were absence of oral anticoagulation exposure, increased body mass index, use of a balloon-expandable bioprosthesis and use of a bioprosthesis with diameter ≤23mm. Antithrombotic treatment crossover (i.e. oral anticoagulation interruption or introduction during follow-up) occurred in 9.6% of patients, and was a risk factor for death (adjusted hazard ratio 3.39, 95% confidence interval 1.63-7.07).
Baseline characteristics, rather than oral anticoagulation prescription at discharge, were associated with adverse outcomes following successful transcatheter aortic valve implantation. Conversely, oral anticoagulation was associated with reduced valvular haemodynamic deterioration.
经导管主动脉瓣置换术后口服抗凝对临床和血液动力学结果的影响尚不清楚。
评估经导管主动脉瓣置换术后 1 年内口服抗凝的效果。
前瞻性纳入 2010 年至 2016 年在法国两个三级中心接受经导管主动脉瓣置换术的所有患者。根据 Valve Academic Research Consortium 2 标准，评估 1 年内死亡、卒、心力衰竭再入院或主要/危及生命的出血的复合终点。瓣叶血液动力学恶化定义为平均跨瓣梯度≥20mmHg 或超声心动图随访时增加≥10mmHg。
在 1139 例患者中，400 例（35.1%）出院时服用口服抗凝剂。与未服用口服抗凝剂相比，服用组的主要终点更常见（29.4% vs. 17.3% vs. 21.5%；危险比 1.83，95%置信区间 1.42-2.35）。复合终点的危险因素为慢性肺部和肾脏疾病、既往心房颤动、出院时左心室射血分数≤30%和股血管入路缺失，但出院时未开口服抗凝药。相反，58 例患者出现瓣叶血液动力学恶化，其中服用组 11 例（19%），未服用组 47 例（81%）。瓣叶血液动力学恶化的危险因素是无口服抗凝暴露、体重指数增加、使用球囊扩张生物假体和使用直径≤23mm 的生物假体。9.6%的患者在随访中发生抗血栓治疗交叉（即口服抗凝中断或引入），是死亡的危险因素（调整后的危险比 3.39，95%置信区间 1.63-7.07）。
与经导管主动脉瓣置换术后不良结局相关的是基线特征，而非出院时开口服抗凝药。相反，口服抗凝与减少瓣叶血液动力学恶化相关。
