Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning opti...Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.展开更多
Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,ca...Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care unit.In general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older age.COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury.Indeed,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by HF.The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial dysfunction.The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.展开更多
文摘Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.
文摘Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care unit.In general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older age.COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury.Indeed,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by HF.The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial dysfunction.The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.
