Nei Scott D, Wieruszewski Patrick M, Scott Rachael, Greason Kevin L
Department of Pharmacy, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA.
Am J Cardiovasc Drugs. 2021 Jul;21(4):453-458. doi: 10.1007/s40256-020-00443-9. Epub 2020 Dec 23.
Dual antiplatelet therapy (DAPT) was the initial antithrombotic regimen of choice following transcatheter aortic valve replacement (TAVR). Subsequent identification of subclinical valve thrombosis in high-risk patients has questioned whether warfarin should be used as an alternative to DAPT for some patients.
The aim of this study was to compare thromboembolic events, bleeding, and all-cause mortality between DAPT and warfarin following TAVR.
This was a single-center, retrospective review of TAVR patients who received DAPT or warfarin following TAVR between 2008 and 2018. The primary endpoint was occurrence of thromboembolic events during the hospital stay and 1-year follow-up, while secondary endpoints included bleeding and all-cause mortality.
Of the included 764 patients, 193 received DAPT and 571 received warfarin. The median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) scores were 8.3% for the DAPT group and 6.5% for the warfarin group. The primary endpoint occurred 30 times (3.9%) during the study timeframe. No differences in thromboembolic events between the DAPT and warfarin groups were found (4.14% vs. 3.85%; p = 0.857), and there was no difference in bleeding (6.22% vs. 5.08%; p = 0.544) or risk of mortality (hazard ratio 0.59, 95% confidence interval 0.33-1.06; p = 0.076).
In this study, warfarin had similar effectiveness and safety, compared with DAPT, for antithrombotic management post-TAVR. For patients whom the provider deemed anticoagulation is indicated, our data suggest warfarin is a well-tolerated option following TAVR in intermediate- and high-risk STS score patients.
双重抗血小板治疗（DAPT）是经导管主动脉瓣置换术（TAVR）后最初选择的抗血栓治疗方案。随后在高危患者中发现亚临床瓣膜血栓形成，这引发了对于某些患者是否应使用华法林替代DAPT的质疑。
本研究的目的是比较TAVR后DAPT与华法林在血栓栓塞事件、出血及全因死亡率方面的差异。
这是一项对2008年至2018年间接受TAVR后使用DAPT或华法林的患者进行的单中心回顾性研究。主要终点是住院期间及1年随访期内血栓栓塞事件的发生情况，次要终点包括出血和全因死亡率。
纳入的764例患者中，193例接受DAPT，571例接受华法林治疗。胸外科医师协会（STS）预测死亡率（PROM）评分中位数在DAPT组为8.3%，在华法林组为6.5%。在研究期间，主要终点事件发生了30次（3.9%）。DAPT组与华法林组在血栓栓塞事件方面未发现差异（4.14%对3.85%；p = 0.857），在出血方面也无差异（6.22%对 5.08%；p = 0.544），死亡率风险也无差异（风险比0.59，9 5%置信区间0.33 - 1.06；p = 0.076）。
在本研究中，与DAPT相比，华法林在TAVR后抗血栓治疗管理方面具有相似的有效性和安全性。对于临床医生认为需要抗凝治疗的患者，我们的数据表明，在STS评分中、高危的患者TAVR后，华法林是一种耐受性良好的选择。
