经导管主动脉瓣置换术后不同抗凝治疗的短期结局

Short-term outcome of patients after transcatheter aortic valve replacement receiving different anticoagulants

目的比较经导管主动脉瓣置换术(TAVR)后合并抗凝指征的患者使用不同抗凝治疗的安全性及有效性。方法本研究为回顾性研究。选取2016年4月至2022年2月在广东省人民医院行TAVR治疗且存在抗凝指征的患者,根据口服抗凝药的种类分为非维生素K拮抗剂口服抗凝药(NOAC)和华法林两组,随访时间为30 d。终点事件包括主要终点及其组分。主要终点为死亡、卒中、心肌梗死、瓣膜血栓、心腔内血栓和大出血的复合终点。比较两组的终点事件发生情况,并采用多因素logistic回归校正混杂因素的影响。结果共入选80例患者,年龄(74.4±7.1)岁,男性43例(53.8%)。其中,NOAC组49例(61.3%),华法林组31例。抗凝指征为心房颤动的患者76例(95.0%)。NOAC组和华法林组相比,校正后的主要终点发生风险(OR=0.23,95%CI 0.06~0.94,P=0.040)更低,主要归因于大出血的风险(OR=0.19,95%CI 0.04~0.92,P=0.039)更低。结论TAVR术后合并抗凝指征的患者使用NOAC的短期结局可能优于华法林,但研究结论尚需大样本随机对照研究的长期随访进一步验证。

Objective To compare the safety and efficacy of different anticoagulants in patients with indications for anticoagulation after transcatheter aortic valve replacement(TAVR).Methods This is a retrospective study.Patients who underwent TAVR from April 2016 to February 2022 in Guangdong Provincial People′s Hospital and had indications for anticoagulation were included and divided into two groups according to the type of anticoagulants,i.e.non-vitamin K antagonist oral anticoagulant(NOAC)and warfarin,and patients were followed up for 30 days.The primary endpoint was the combination of death,stroke,myocardial infarction,valve thrombosis,intracardiac thrombosis and major bleeding.The incidence of endpoints was compared between two groups,and multivariate logistic regression analysis was applied to adjust the bias of potential confounders.Results A total of 80 patients were included.Mean age was(74.4±7.1)years,43(53.8%)were male.Forty-nine(61.3%)patients used NOAC,31 used warfarin,and major indication for anticoagulants was atrial fibrillation(76/80,95.0%).The adjusted risks of the primary endpoint(OR=0.23,95%CI 0.06-0.94,P=0.040)of NOAC were lower than that of warfarin,mainly driven by a lower risk of major bleeding(OR=0.19,95%CI 0.04-0.92,P=0.039).Conclusions The short-term outcome of NOAC is better than that of warfarin in patients with indications for anticoagulation after TAVR.Randomized controlled trials of large sample size with long-term follow-up are needed to further testify this finding.