经导管主动脉瓣置入术后抗栓治疗研究进展

Research progress of antithrombotic therapy after transcatheter aortic valve implantation

2002年首例患者接受经导管主动脉瓣置换术(TAVI)以来,目前全球已有超过1万人从中获益。然而,TAVI术后可出现出血、血栓、心律失常、脑血管事件甚至死亡等许多并发症。尽管当前经验和技术均有所提高,围手术期及TAVI术后的缺血和出血并发症仍然普遍存在,并严重影响患者的预后。因此,权衡出血与血栓风险对指导接受TAVI手术患者的抗栓策略至关重要。但目前并无针对此问题的专家共识和推荐,相关指南的证据水平相对较低。本文对TAVI术后抗栓治疗的现有文献进行综述,旨在为临床诊疗及开展进一步研究提供思路。

Since the first patient underwent transcatheter aortic valve implantation(TAVI)in 2002,more than 10,000 people around the world have benefited from it.However,many complications such as bleeding,thrombosis,arrhythmia,cerebrovascular events and even death can occur after TAVI.Although the current experience and technology have improved,the complications of ischemia and bleeding are still common in perioperative period and after TAVI,which seriously affect the prognosis of the patients.Therefore,it is very important to weigh the risk of bleeding and thrombosis to guide the antithrombotic strategy for the patients undergoing TAVI surgery.However,there is no expert consensus and recommendation about this issue at present,and the evidence level of the relevant guidelines is relatively low.This paper reviews the existing literatures on antithrombotic therapy after TAVI,aiming at providing ideas for clinical diagnosis and treatment and further research.