Rodriguez Mejia Ricardo A, Acker Eric, Dao Vinh, Rana Humza
Department of Hospital Medicine, Cape Fear Valley Medical Center, Fayetteville, NC 28304, USA.
Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC 28304, USA.
J Clin Med. 2025 Jul 2;14(13):4690. doi: 10.3390/jcm14134690.
: The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) remains uncertain. Limited data exist comparing novel oral anticoagulants (NOACs) with standard antiplatelet therapy in this population. : We conducted a retrospective analysis of 171 patients who underwent TAVR between January 2018 and August 2024. Patients were categorized according to the discharge antithrombotic regimen as follows: NOACs (n = 27, 16%), vitamin K antagonists (VKAs; n = 8, 5%), and antiplatelet therapy only (APT-only; aspirin and/or clopidogrel without oral anticoagulation; n = 136, 79%). Due to the small VKA sample size, the primary analysis compared NOACs with APT-only. VKA outcomes were reported descriptively without statistical comparisons. : Compared with APT-only, NOAC users had significantly higher 30-day mortality (33% vs. 12%, = 0.017) and 1-year mortality (41% vs. 20%, = 0.048). NOACs were associated with higher rates of major adverse cardiovascular events (MACCE) at 30 days (22% vs. 8%, = 0.051) and 1 year (34% vs. 17%, < 0.001). After inverse probability treatment weighting, NOACs showed increased odds of 30-day MACCE (OR 5.59, 95% CI 2.56-12.18, < 0.001) and increased hazard of 1-year mortality (HR 2.22, 95% CI 1.22-4.03, = 0.009). : NOAC use was associated with inferior outcomes compared to antiplatelet therapy in post-TAVR patients, although residual confounding cannot be excluded. Given the limited sample size and retrospective design, these hypothesis-generating findings require validation in larger prospective studies before they can influence clinical practice.
经导管主动脉瓣置换术（TAVR）后的最佳抗栓治疗仍不明确。在这一人群中，比较新型口服抗凝药（NOACs）与标准抗血小板治疗的数据有限。
我们对2018年1月至2024年8月期间接受TAVR的171例患者进行了回顾性分析。根据出院时的抗栓方案，将患者分为以下几类：NOACs（n = 27，16%）、维生素K拮抗剂（VKAs；n = 8，5%）和仅抗血小板治疗（仅APT；阿司匹林和/或氯吡格雷，无口服抗凝；n = 136，79%）。由于VKA样本量较小，主要分析将NOACs与仅APT进行比较。VKA的结果进行了描述性报告，未进行统计学比较。
与仅APT相比，使用NOACs的患者30天死亡率显著更高（33%对12%，P = 0.017），1年死亡率也更高（41%对20%，P = 0.048）。NOACs与30天时更高的主要不良心血管事件（MACCE）发生率相关（22%对8%，P = 0.051），1年时也是如此（34%对17%，P < 0.001）。在进行逆概率治疗加权后，NOACs显示30天MACCE的几率增加（OR 5.59，95%CI 2.56 - 12.18，P < 0.001），1年死亡率的风险增加（HR 2.22，95%CI 1.22 - 4.03，P = 0.009）。
与TAVR术后患者的抗血小板治疗相比，使用NOACs与较差的预后相关，尽管不能排除残留混杂因素。鉴于样本量有限和回顾性设计，这些产生假设的发现需要在更大规模的前瞻性研究中得到验证，才能影响临床实践。
