Hindi Mathew N, Akodad Mariama, Nestelberger Thomas, Sathananthan Janarthanan
Centre for Cardiovascular and Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Struct Heart. 2022 Sep 15;6(5):100085. doi: 10.1016/j.shj.2022.100085. eCollection 2022 Oct.
Transcatheter aortic valve replacement (TAVR) is an established procedure for the treatment of patients with severe aortic stenosis. The optimal antithrombotic regimen following TAVR, currently unknown and inconsistently applied, is impacted by thromboembolic risk, frailty, bleeding risk, and comorbidities. There is a quickly growing body of literature examining the complex issues underlying antithrombotic regimens post-TAVR. This review provides an overview of thromboembolic and bleeding events following TAVR, summarizes the evidence regarding optimal antiplatelet and anticoagulant use post-TAVR, and highlights current challenges and future directions. By understanding appropriate indications and outcomes associated with different antithrombotic regimens post-TAVR, morbidity and mortality can be minimized in a generally frail and elderly patient population.
经导管主动脉瓣置换术（TAVR）是治疗重度主动脉瓣狭窄患者的既定手术。TAVR术后的最佳抗栓方案目前尚不清楚且应用不一致，会受到血栓栓塞风险、身体虚弱程度、出血风险和合并症的影响。有越来越多的文献在研究TAVR术后抗栓方案背后的复杂问题。本综述概述了TAVR术后的血栓栓塞和出血事件，总结了TAVR术后最佳抗血小板和抗凝治疗的证据，并强调了当前的挑战和未来的方向。通过了解TAVR术后不同抗栓方案的适当适应症和结果，可以在普遍身体虚弱的老年患者群体中将发病率和死亡率降至最低。
