Christersson Christina, Ståhle Elisabeth, Lindhagen Lars, James Stefan
Department of Medical Sciences, Cardiology, Uppsala University, SE 75185 Uppsala, Sweden.
Department of Surgical Sciences, Thoracic surgery, Uppsala University, SE 75185 Uppsala, Sweden.
Eur Heart J Suppl. 2020 Apr;22(Suppl C):C26-C33. doi: 10.1093/eurheartj/suaa007. Epub 2020 Apr 29.
The majority of patients with severe aortic stenosis are recommended intervention with a surgical biological prosthesis (bioSAVR) or a transcatheter aortic valve intervention (TAVI). The antithrombotic strategies after aortic valve intervention vary and include drugs targeting both platelets and the coagulation cascade. Long-term exposure and changes of antithrombotic treatment influence the risk of both bleeding and thromboembolic events.The aim was to describe an unselected sample of patients who have experienced haemorrhagic stroke and other major bleeding events after biological aortic prosthesis, their antithrombotic treatment and changes of treatments in relation to the bleeding event.All patients performing an bioSAVR or a TAVI 2008-2014 were identified in the SWEDEHEART registry and included in the study ( = 10 711). The outcome events were haemorrhagic stroke and other major bleeding event. Information of drug exposure was collected from the dispensed drug registry.The incidence rate of any bleeding event was 2.85/100 patient-years the first year after aortic valve intervention. Heart failure and atrial fibrillation were present more often in patients with a first haemorrhagic stroke or other major bleeding event compared to without. The proportion of exposure to warfarin was 28.7% vs. 21.3% in patients with and without a haemorrhagic stroke. Comparable figures were 31.2% vs. 19.0% in patients with and without other major bleeding event. During 1 month prior a haemorrhagic stroke or other major bleeding event 39.4% and 38.0%, respectively, of the patients not previously exposed to antithrombotic treatment started warfarin or single antiplatelet therapy.Major bleeding events are not uncommon after aortic valve intervention with a biological prosthesis. Evaluation of comorbidities and previous bleeding might improve risk stratification for bleeding in these elderly patients. The pattern of change of antithrombotic treatment was similar in the groups with and without a bleeding event and in most patients the antithrombotic regime was unchanged the month before an event.
大多数重度主动脉瓣狭窄患者建议接受手术生物瓣膜置换术（bioSAVR）或经导管主动脉瓣介入治疗（TAVI）。主动脉瓣介入治疗后的抗栓策略各不相同，包括针对血小板和凝血级联反应的药物。长期使用抗栓治疗及其变化会影响出血和血栓栓塞事件的风险。本研究旨在描述一组未经选择的在接受生物主动脉瓣置换术后发生出血性卒中及其他重大出血事件的患者样本，以及他们的抗栓治疗情况和与出血事件相关的治疗变化。通过瑞典心脏注册研究（SWEDEHEART）确定了2008年至2014年期间接受bioSAVR或TAVI治疗的所有患者（n = 10711），并纳入研究。结局事件为出血性卒中和其他重大出血事件。药物暴露信息从配药登记处收集。主动脉瓣介入治疗后第一年，任何出血事件的发生率为2.85/100患者年。与未发生首次出血性卒中或其他重大出血事件的患者相比，发生此类事件的患者更常出现心力衰竭和心房颤动。发生出血性卒中的患者中使用华法林的比例为28.7%，未发生出血性卒中的患者为21.3%。在有无其他重大出血事件的患者中，这一比例分别为31.2%和19.0%。在发生出血性卒中或其他重大出血事件前1个月，分别有39.4%和38.0%此前未接受抗栓治疗的患者开始使用华法林或单一抗血小板治疗。使用生物瓣膜进行主动脉瓣介入治疗后，重大出血事件并不少见。评估合并症和既往出血情况可能会改善这些老年患者出血的风险分层。有出血事件和无出血事件的两组患者抗栓治疗的变化模式相似，且在大多数患者中，抗栓方案在事件发生前1个月未改变。
