外科生物人工主动脉瓣置换术后短期口服抗凝的效果

Effects of short-term oral anticoagulation following surgical bioprosthetic aortic valve replacement.

作者信息

Ko Tsung-Yu, Lin Jui-Hsiang, Huang Kuan-Chih, Wei Ling-Yi, Ho Yi-Lwun, Kao Hsien-Li, Yu Hsi-Yu

机构信息

Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.

Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.

出版信息

J Formos Med Assoc. 2023 Jan;122(1):58-64. doi: 10.1016/j.jfma.2022.08.006. Epub 2022 Aug 31.

DOI:10.1016/j.jfma.2022.08.006

PMID:36057527

Abstract

BACKGROUND

Short-term oral anticoagulation (OAC) is recommended for patients after surgical bioprosthetic aortic valve replacement (bAVR); however, the potential benefits remain controversial. This study evaluated the effects of short-term OAC following bAVR.

METHODS

From 2010 to 2017, total 450 patients who underwent bAVR were enrolled. The outcomes of patients who did (OAC group) and who did not receive OAC (without-OAC group) after bAVR were compared. Propensity-score matching (PSM) was used to adjust for potential confounders, and a 1:1 matched cohort was formed. The main outcomes were all-cause mortality and bioprosthetic valve dysfunction (BVD).

RESULTS

A total of 175 (39%) patients received OAC after bAVR. The median follow-up period was 2.9 years, the median duration of OAC use was 4 months; 162 pairs of patients were identified after the PSM. There was no significant difference in the prevalence of 1-year embolism/ischemic stroke between the OAC and without-OAC group in PSM cohort (0.62% vs. 1.89% for embolism, p = 0.623; 0 vs. 1.23% for ischemic stroke, p = 0.499). The prevalence of 1-year intracranial hemorrhage (ICH) between OAC and without-OAC group was also comparable (0.62% vs. 0.62%, p = 1). The OAC group had a lower all-cause mortality (adjusted hazard ratio (aHR):0.488, 95% confidence interval (CI): 0.259-0.919). There was also a trend for reduced BVD in the OAC group (aHR: 0.661, 95% CI: 0.339-1.290).

CONCLUSION

Our study demonstrated that short-term OAC use after bAVR was associated with lower all-cause mortality. The prevalence of 1-year embolism/ischemic stroke/ICH were comparable despite of OAC use.

摘要

背景

对于接受外科生物人工心脏主动脉瓣置换术（bAVR）的患者，推荐进行短期口服抗凝治疗（OAC）；然而，其潜在益处仍存在争议。本研究评估了bAVR术后短期OAC的效果。

方法

纳入2010年至2017年间总共450例行bAVR的患者。比较bAVR术后接受OAC治疗的患者（OAC组）和未接受OAC治疗的患者（非OAC组）的结局。采用倾向评分匹配（PSM）来调整潜在混杂因素，并形成1:1匹配队列。主要结局为全因死亡率和生物人工瓣膜功能障碍（BVD）。

结果

共有175例（39%）患者在bAVR术后接受了OAC治疗。中位随访期为2.9年，OAC使用的中位持续时间为4个月；PSM后确定了162对患者。在PSM队列中，OAC组和非OAC组1年栓塞/缺血性卒中的发生率无显著差异（栓塞发生率分别为0.62%和1.89%，p = 0.623；缺血性卒中发生率分别为0和1.23%，p = 0.499）。OAC组和非OAC组1年颅内出血（ICH）的发生率也相当（分别为0.62%和0.62%，p = 1）。OAC组的全因死亡率较低（调整后风险比（aHR）：0.488，95%置信区间（CI）：0.259 - 0.919）。OAC组的BVD也有降低趋势（aHR：0.661，95%CI：0.339 - 1.290）。