Heart:抗凝治疗对经导管主动脉瓣置换术后瓣膜血流动力学恶化的影响!

2018-02-14 xing.T MedSci原创

由此可见,TAVR后未进行抗凝治疗与跨瓣压差显著增加和风险更大的VHD相关。VHD在大多数情况下处于亚临床状态,并与主要临床不良事件无关。未来需要进行随机试验来确定TAVR后进行全身抗凝治疗是否可以降低VHD的发病率。

近日,在心脏病领域权威杂志Heart上发表了一篇研究文章,研究人员旨在根据使用的抗凝治疗情况探讨经导管主动脉瓣置换(TAVR)后跨瓣压差的变化及瓣膜血流动力学恶化(VHD)。

该多中心研究纳入了2466例接受TAVR的患者(46%为男性;平均年龄为81±7岁),并随访12个月后行超声心动图检查。TAVR术后707例(28.7%)患者进行抗凝治疗(AC组)。共有663名患者接受维生素K拮抗剂治疗,44名患者接受直接口服抗凝剂治疗。研究人员采用倾向评分匹配分析来调整组间(TAVR-AC vs. non-AC)差异。


该研究共有622例患者被纳入倾向匹配分析。VHD被定义为随访期间平均跨瓣压差增加≥10mmHg。平均临床随访时间为29±18个月。在非AC组随访期间平均跨瓣梯度显著增加(P=0.003),而AC组仍然维持稳定(P=0.323)。在AC组VHD的发生率明显降低(0.6%),相比于非AC组(3.7%,P<0.001),而这些差异在倾向匹配的人群中仍然存在(AC组和非AC组分别为0.6% vs. 3.9%,P<0.001)。VHD的发生也与随访期间全因死亡(P=0.468)、心血管死亡(P=0.539)或卒中(P=0.170)风险增加无关。

由此可见,TAVR后未进行抗凝治疗与跨瓣压差显著增加和风险更大的VHD相关。VHD在大多数情况下处于亚临床状态,并与主要临床不良事件无关。未来需要进行随机试验来确定TAVR后进行全身抗凝治疗是否可以降低VHD的发病率。

原始出处:

María Del Trigo,et al. Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement. Heart. 2018. http://dx.doi.org/10.1136/heartjnl-2017-312514

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    2018-02-16 zhaojie88
  5. 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  7. 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  8. 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    2018-02-16 lsj631
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    2018-02-16 slcumt

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