First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece.
Curr Pharm Des. 2020;26(23):2789-2803. doi: 10.2174/1381612826666200413083746.
While surgical aortic valve replacement (SAVR) was for years the only available treatment for symptomatic aortic stenosis, the introduction of transcatheter aortic valve implantation (TAVI) in 2002 and the improvement of its technical aspects in the following years, has holistically changed the synchronous therapeutic approach of aortic valve stenosis. Recent evidence has expanded the indication of TAVI from high to lower surgical risk populations with symptomatic aortic stenosis. The administration of antithrombotic therapy periprocedurally and its maintenance after a successful TAVI is crucial for the prevention of complications and affects postprocedural survival. Randomized controlled trials investigating the appropriate combination and the duration of antithrombotic treatment after TAVI are for the moment scarce. This review article sheds light on the underlying pathogenetic mechanisms contributing in periprocedural TAVI thrombotic complications and discuss the efficacy of current antithrombotic policies as evaluated in randomized trials.
虽然外科主动脉瓣置换术 (SAVR) 多年来一直是治疗有症状的主动脉瓣狭窄的唯一可用方法，但 2002 年经导管主动脉瓣植入术 (TAVI) 的引入以及随后几年其技术方面的改进，从整体上改变了主动脉瓣狭窄的同步治疗方法。最近的证据已经将 TAVI 的适应证从高危人群扩展到有症状的主动脉瓣狭窄的低危人群。围手术期应用抗血栓治疗及其在成功 TAVI 后的维持对于预防并发症至关重要，并影响术后生存。目前，关于 TAVI 后抗血栓治疗的合适组合和持续时间的随机对照试验还很少。这篇综述文章阐明了导致 TAVI 围手术期血栓并发症的潜在发病机制，并讨论了随机试验评估的当前抗血栓治疗策略的疗效。
