Ren Yu, Chen Jing, Wang Suchun, Jiang Zhengli, Luo Hua
Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China.
Front Pharmacol. 2025 Jun 11;16:1531361. doi: 10.3389/fphar.2025.1531361. eCollection 2025.
This study comprehensively evaluates the safety and efficacy of three antithrombotic regimens following Transcatheter Aortic Valve Implantation (TAVI), focusing on thrombotic and bleeding complications to provide data-driven insights for optimizing postoperative management.
A retrospective cohort analysis included 58 TAVI patients from two medical centers (from August 2022 to July 2024). Patients were assigned to three regimens post-TAVI: Group A (warfarin for 3-6 months transitioned to lifelong aspirin), Group B (warfarin transitioned to rivaroxaban), and Group C (dual antiplatelet therapy transitioned to aspirin). Key exclusion criteria were concurrent cardiac surgeries and severe hepatic or renal dysfunction. Primary outcomes included transfusion rates, bleeding incidents, and thrombotic events. Secondary outcomes included coagulation parameters [international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer] and postoperative hospital stay duration.
Transfusion requirements did not differ significantly across groups (p = 0.576). However, significant differences were noted in bleeding events (p = 0.034) and hospital stay duration (p < 0.001) among groups. Group B (warfarin transitioned to rivaroxaban) had the lowest bleeding incidence (0%) and the shortest hospital stay (8.71 ± 3.58 days), compared to Group A (37.5%, 14.71 ± 7.61 days) and Group C (30.0%, 7.50 ± 2.84 days). Transfusion requirements and thrombotic event rates were comparable across groups. APTT was significantly prolonged in Group C (p < 0.001), without corresponding clinical bleeding.
Each antithrombotic regimen presented unique clinical benefits and limitations. Transitioning from warfarin to rivaroxaban was associated with a significantly reduced risk of bleeding and shorter hospital stays. Transitioning from dual antiplatelet therapy to aspirin monotherapy significant prolonged APTT without increasing clinical bleeding events. These findings highlight the importance of tailored antithrombotic strategies to optimize post-TAVI outcomes.
本研究全面评估经导管主动脉瓣植入术（TAVI）后三种抗栓方案的安全性和有效性，重点关注血栓形成和出血并发症，为优化术后管理提供数据驱动的见解。
一项回顾性队列分析纳入了来自两个医疗中心（2022年8月至2024年7月）的58例TAVI患者。患者在TAVI术后被分配到三种方案：A组（华法林使用3 - 6个月后过渡为终身服用阿司匹林）、B组（华法林过渡为利伐沙班）和C组（双联抗血小板治疗过渡为阿司匹林）。主要排除标准为同期心脏手术和严重肝肾功能不全。主要结局包括输血率、出血事件和血栓形成事件。次要结局包括凝血参数[国际标准化比值（INR）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、D - 二聚体]和术后住院时间。
各组间输血需求无显著差异（p = 0.576）。然而，各组间在出血事件（p = 0.034）和住院时间（p < 0.001）方面存在显著差异。与A组（37.5%，14.71 ± 7.61天）和C组（30.0%，7.50 ± 2.84天）相比，B组（华法林过渡为利伐沙班）的出血发生率最低（0%），住院时间最短（8.71 ± 3.58天）。各组间输血需求和血栓形成事件发生率相当。C组的APTT显著延长（p < 0.001），但无相应的临床出血。
每种抗栓方案都有独特的临床益处和局限性。从华法林过渡到利伐沙班与出血风险显著降低和住院时间缩短相关。从双联抗血小板治疗过渡到阿司匹林单药治疗显著延长了APTT，但未增加临床出血事件。这些发现凸显了定制抗栓策略以优化TAVI术后结局的重要性。
