MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC.
MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC; MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Am J Cardiol. 2023 Nov 1;206:108-115. doi: 10.1016/j.amjcard.2023.08.076. Epub 2023 Sep 8.
Subclinical leaflet thrombosis occurs with transcatheter heart valves (THVs) and could be associated with structural valve deterioration. The current guidelines recommend the use of antiplatelet agents after transcatheter aortic valve replacement (TAVR) but not the routine use of oral anticoagulation. Our study examines the effects of short-term warfarin therapy on THV hemodynamics at 24 months after TAVR in low-risk patients. Low-risk patients who underwent TAVR were randomly allocated 1:1 to receive low-dose aspirin (n = 50) or low-dose aspirin plus warfarin (n = 44). After 30 days of treatment, ongoing medication regimens, including anticoagulation, were at the physicians' discretion. Follow-up after a period of 24 months was available for clinical and echocardiographic outcomes. At the 24-month mark, follow-up echocardiography of the randomly allocated patients revealed just 1 additional case of new structural valve deterioration in the aspirin group (compared with the occurrence within 30 days), based on the Valve Academic Research Consortium 3 definitions. There were also no differences in mean pressure gradients (11.5 ± 0.5 mm Hg vs 11.05 ± 4.0 mm Hg, p = 0.6) or peak velocity (2.2 ± 0.5 m/s vs 2.1 ± 0.4 m/s, p = 0.7) between the groups. A composite end point (mortality, stroke, and myocardial infarction) did not show any difference between the groups at long-term follow-up (p = 0.07). In conclusion, in low-risk patients who underwent TAVR, short-term anticoagulation with warfarin did not impact clinical outcomes or THV hemodynamics by echocardiography at 24 months.
经导管心脏瓣膜（THV）会发生亚临床瓣叶血栓形成，可能与结构性瓣膜退化有关。目前的指南建议在经导管主动脉瓣置换术（TAVR）后使用抗血小板药物，但不常规使用口服抗凝剂。我们的研究检查了 TAVR 后低危患者短期华法林治疗对 THV 血流动力学的影响，这些患者在 24 个月时。低危患者被随机 1:1 分配接受低剂量阿司匹林（n=50）或低剂量阿司匹林加华法林（n=44）。治疗 30 天后，继续的药物治疗方案，包括抗凝，由医生决定。24 个月后可获得临床和超声心动图结果。在 24 个月的标记处，随机分配患者的超声心动图随访显示，在阿司匹林组中仅发现 1 例新的结构性瓣膜恶化（与 30 天内发生的瓣膜恶化相比），基于瓣膜学术研究联盟 3 项定义。两组之间的平均压力梯度（11.5±0.5mmHg 与 11.05±4.0mmHg，p=0.6）或峰值速度（2.2±0.5m/s 与 2.1±0.4m/s，p=0.7）也没有差异。长期随访时，复合终点（死亡、卒中和心肌梗死）在两组之间没有差异（p=0.07）。总之，在接受 TAVR 的低危患者中，华法林短期抗凝治疗在 24 个月时并未影响临床结果或经超声心动图评估的 THV 血流动力学。
