经导管主动脉瓣置换术后抗栓治疗进展

Antithrombotic Therapy After Transcatheter Aortic Valve Replacement

经导管主动脉瓣置换术(TAVR)是严重主动脉瓣狭窄患者的一种治疗选择。TAVR术后存在血栓事件风险,需长期口服抗栓药物,但行TAVR的患者大部分系基础疾病多及合并多种并发症的老年人,长期服用抗栓药物易导致出血风险增加,这使抗栓治疗方案变得复杂;因此,确定最佳抗栓治疗方案尤为重要。目前常见的抗栓策略包括单药抗血小板治疗、双联抗血小板治疗及口服抗凝药物治疗等。作为一个近年来新兴发展的手术方式,TAVR术后血栓及出血风险评估尚缺乏明确的循证医学证据,鉴于此,笔者团队针对TAVR术后抗栓治疗做综述分析。

Transcatheter aortic valve replacement(TAVR)is a treatment option for patients with severe aortic stenosis.There is a risk of thrombotic events after TAVR,which requires long-term oral antithrombotic drugs.However,most of the patients undergoing TAVR are elderly with multiple underlying diseases and complications,and long-term use of antithrombotic drugs is prone to increase the risk of bleeding,which makes the antithrombotic treatment plan complicated.Therefore,it is very important to determine the best antithrombotic treatment.At present,common antithrombotic strategies include single drug antiplatelet therapy,dual antiplatelet therapy and oral anticoagulant therapy.As a newly developed surgical method in recent years,there is still a lack of clear evidence-based evidence for the risk assessment of postoperative thrombosis and hemorrhage after TAVR.In view of this,we conducted a review and analysis of postoperative antithrombotic therapy for TAVR.