Ya'Qoub Lina, Arnautovic Jelena, Sharkawi Musa, AlAasnag Mirvat, Jneid Hani, Elgendy Islam Y
Division of Structural Heart Disease, University of California (San Francisco), San Francisco, CA 93106, USA.
Division of Interventional Cardiology, Henry Ford Macomb Hospital, Clinton Twp, MI 48038, USA.
J Clin Med. 2023 Dec 12;12(24):7632. doi: 10.3390/jcm12247632.
There have been significant changes in the optimal antithrombotic regimen post transcatheter aortic valve implantation (TAVI) after the results of major clinical trials in the past few years. Given the clinical importance of the optimal antithrombotic therapy post TAVI, we performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes, as well the current guideline recommendations and knowledge gaps.
We performed a narrative description of the major clinical trials behind the scientific evidence supporting these changes. We used PubMed as a major source to collect the major clinical trials including the following key words: "transcatheter aortic valve replacement", "transcatheter aortic valve implantation", "antithrombotic", "antiplatelet" and "anticoagulation". We selected the major clinical trials on this topic. This is not a systematic review or meta-analysis.
We describe the results of the major clinical trials on antithrombotic therapy post TAVI: POPULAR-TAVI A, POPULAR-TAVI B, ENVISAGE-TAVI AF, GALILEO, ATLANTIS and ADAPT-TAVR trials. Based on the results of these trials, single antiplatelet therapy is recommended post TAVI in patients without concomitant indication for oral anticoagulation or dual antiplatelet therapy, especially in elderly patients. In younger patients, it is advised to evaluate the patient's bleeding and thrombotic risk, and dual antiplatelet therapy may be reasonable in patients with a high thrombotic risk and low bleeding risk. In patients with a concurrent indication for oral anticoagulation or dual antiplatelet therapy, it is recommended to continue oral anticoagulation or dual antiplatelet therapy post TAVI.
In most patients without concomitant indication for oral anticoagulation, single antiplatelet therapy is recommended post TAVI.
在过去几年的主要临床试验结果公布后，经导管主动脉瓣植入术（TAVI）后的最佳抗栓治疗方案发生了重大变化。鉴于TAVI后最佳抗栓治疗的临床重要性，我们对支持这些变化的科学证据背后的主要临床试验、当前指南建议以及知识空白进行了叙述性描述。
我们对支持这些变化的科学证据背后的主要临床试验进行了叙述性描述。我们以PubMed作为主要来源，收集主要临床试验，关键词包括：“经导管主动脉瓣置换术”、“经导管主动脉瓣植入术”、“抗栓”、“抗血小板”和“抗凝”。我们选择了关于该主题的主要临床试验。这不是一项系统评价或荟萃分析。
我们描述了TAVI后抗栓治疗的主要临床试验结果：POPULAR-TAVI A、POPULAR-TAVI B、ENVISAGE-TAVI AF、GALILEO、ATLANTIS和ADAPT-TAVR试验。基于这些试验结果，对于无口服抗凝或双联抗血小板治疗伴随指征的患者，TAVI后推荐单药抗血小板治疗，尤其是老年患者。对于年轻患者，建议评估患者的出血和血栓形成风险，对于血栓形成风险高且出血风险低的患者，双联抗血小板治疗可能是合理的。对于有口服抗凝或双联抗血小板治疗伴随指征的患者，建议TAVI后继续口服抗凝或双联抗血小板治疗。
在大多数无口服抗凝伴随指征的患者中，TAVI后推荐单药抗血小板治疗。
