Langenaeken Tom, Vanoppen Arnaud, Janssens Fien, Tanghe Loes, Verbrugghe Peter, Rega Filip, Meuris Bart
Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
J Clin Med. 2023 Jul 28;12(15):4984. doi: 10.3390/jcm12154984.
Valvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but it is far from perfect. Direct oral anticoagulants (DOACs) are a new and more patient-friendly alternative to warfarin when anticoagulation is required, but have not yet been approved for the indication of mechanical valves.
A literature search of Pubmed, Embase, Web of Science (Core Collection), and Cochrane Library (from inception to May 2023) was performed using a search string that was well defined and not modified during the study. An extensive overview of the search terms used in each database can be found in the Appendix. Only prospective clinical trials were included in this review. A total of 10 publications were included in this review.
This systematic review summarizes the different types of DOACs and their possible use in the anticoagulation of mechanical valves. We aim to propose future directions in anticoagulation research for mechanical valves.
DOAC use in MHVs has been halted due to the failure of both dabigatran and apixaban in two major clinical trials. However, rivaroxaban was successful in two small clinical trials. Ample research is still needed to explore new valve designs as well as new anticoagulation targets.
心脏瓣膜病是一种常见疾病，常需进行瓣膜置换。机械心脏瓣膜（MHV）因其耐久性较长，常用于年轻患者。其主要缺点是需要终身抗凝。华法林被认为是标准治疗方法，但远非完美。当需要抗凝时，直接口服抗凝剂（DOAC）是一种新的、对患者更友好的华法林替代药物，但尚未被批准用于机械瓣膜适应症。
使用在研究期间定义明确且未修改的检索词，对PubMed、Embase、科学网（核心合集）和考克兰图书馆（从创刊到2023年5月）进行文献检索。每个数据库中使用的检索词的详细概述见附录。本综述仅纳入前瞻性临床试验。本综述共纳入10篇出版物。
本系统综述总结了不同类型的DOAC及其在机械瓣膜抗凝中的可能用途。我们旨在提出机械瓣膜抗凝研究的未来方向。
由于达比加群和阿哌沙班在两项主要临床试验中失败，DOAC在MHV中的使用已停止。然而，利伐沙班在两项小型临床试验中取得了成功。仍需要大量研究来探索新的瓣膜设计以及新的抗凝靶点。
