Structural Heart & Valve Center, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York.
JAMA Cardiol. 2022 Aug 1;7(8):866-872. doi: 10.1001/jamacardio.2022.1591.
Subclinical leaflet thrombosis affects approximately 15% of patients after transcatheter aortic valve replacement (TAVR). The pathophysiology and clinical significance of leaflet thrombosis remain incompletely understood. Defining the optimal management strategy in patients who are asymptomatic, including the role for oral anticoagulation (OAC), is a key challenge for the field.
Three recent randomized trials have evaluated the role of OAC in patients after TAVR. These studies have confirmed prior observational data suggesting that OAC is effective at prevention of subclinical leaflet thrombosis. Overall, however, OAC does not lead to a clinical benefit over the period studied, and in some patients may be harmful owing to bleeding risk.
Strategies for identification of patients in whom the benefit of OAC outweighs the risks are required for optimization of long-term outcome after TAVR. This requires clearer insights into the mechanisms of asymptomatic leaflet thrombosis, its clinical significance, and patient-specific risks of bleeding and structural valve degeneration.
经导管主动脉瓣置换术（TAVR）后，约 15%的患者存在亚临床瓣叶血栓形成。瓣叶血栓形成的病理生理学和临床意义仍不完全清楚。对于无症状患者，包括口服抗凝剂（OAC）的作用，定义最佳管理策略是该领域的一个关键挑战。
最近三项随机试验评估了 TAVR 后 OAC 在患者中的作用。这些研究证实了先前的观察性数据，表明 OAC 可有效预防亚临床瓣叶血栓形成。然而，总体而言，OAC 在研究期间并未带来临床获益，并且在某些患者中可能由于出血风险而有害。
需要制定策略来识别 OAC 获益超过风险的患者，以优化 TAVR 后的长期预后。这需要更清楚地了解无症状瓣叶血栓形成的机制、其临床意义以及出血和结构性瓣膜退化的患者特异性风险。
