Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
J Am Coll Cardiol. 2023 Feb 21;81(7):684-702. doi: 10.1016/j.jacc.2022.11.050.
Transcatheter aortic valve replacement (TAVR) has gained over time a major reduction in procedural complications. Despite this, clinically relevant bleeding still occurs in a non-negligible proportion of patients and adversely affects prognosis. Patients with severe aortic stenosis are at heightened risk for spontaneous bleeding due to advanced age and a high comorbidity burden. Also, procedural factors and antithrombotic management contribute to define individual bleeding susceptibility. Bleeding prevention represents an emerging area for improving patient care. Because of the tight hemorrhagic/ischemic balance, a tailored approach based on individual bleeding-risk profile, such as a less invasive antithrombotic regimen or appropriate diagnostic preprocedural evaluation, should be pursued to avoid bleeding events. This review aims to provide an in-depth overview of bleeding events in the TAVR field, including definitions, timing and the extent of risk, and clinical impact, as well as updates on antithrombotic management and its potential influence on bleeding complications.
经导管主动脉瓣置换术（TAVR）在一定程度上降低了手术相关并发症。尽管如此，临床上仍有相当比例的患者发生有临床意义的出血，且对预后有不良影响。由于高龄和高合并症负担，严重主动脉瓣狭窄患者自发性出血的风险增加。此外，手术相关因素和抗栓管理也会导致个体出血易感性的差异。预防出血是改善患者治疗的新兴领域。由于出血/缺血之间的平衡非常紧密，应根据个体出血风险概况采取个体化的方法，例如采用侵袭性较小的抗栓方案或适当的术前诊断评估，以避免出血事件的发生。本综述旨在深入探讨 TAVR 领域的出血事件，包括定义、时间和风险程度以及对临床的影响，以及抗栓管理的最新进展及其对出血并发症的潜在影响。
