经导管主动脉瓣植入术后抗血栓治疗研究进展  

Research progress of antithrombotic therapy after transcatheter aortic valve implantation

作　　者：常超[1] 姜楠[1] CHANG Chao;JIANG Nan(Department of Cardiovascular Surgery,Tianjin Chest Hospital,Tianjin,300051,P.R.China)

机构地区：[1]天津市胸科医院心脏大血管外科,天津300051

出　　处：《中国胸心血管外科临床杂志》2020年第6期710-715,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：天津市科学技术委员会慢性病重大专项(16ZXMJSY00160)。

摘　　要：传统的外科主动脉瓣置换术风险较高,可能导致严重的并发症,尤其是高龄、术前合并其它疾病无法接受开胸手术的患者。因此,经导管主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)现已成为常规外科瓣膜置换术高风险、有症状的严重主动脉瓣狭窄患者的标准治疗方法。目前,指南建议没有口服抗凝药物指征的患者使用双重抗血小板治疗来预防TAVI术后的血栓栓塞事件。但是,该策略是经验性的,主要基于经皮冠状动脉介入治疗领域的专家共识。抗血栓治疗过程与血栓形成和发生出血并发症显著相关,因此,达到抗血栓形成和预防出血风险之间的平衡至关重要。本文就当前的指南及支持证据进行综述,探讨在TAVI术后抗血小板和/或抗凝血治疗的合理策略。Traditional surgical aortic valve replacement is associated with a high risk of serious complications,especially in elderly patients with other preoperative diseases and unable to undergo thoracotomy.Therefore,transcatheter aortic valve implantation(TAVI)is now the accepted standard treatment for patients with symptomatic severe aortic stenosis at elevated risk for conventional surgical valve replacement.Currently,guidelines propose the use of dual antiplatelet therapy for the prevention of thromboembolic events after TAVI in the patients without an indication for oral anticoagulation.While,this strategy is empiric and largely based on expert consensus extrapolated from the arena of percutaneous coronary intervention.Antithrombotic therapy is associated with a significant occurrence of both thrombotic and bleeding complications,thus,the balance between thrombotic and bleeding risk is critical.This review summarizes current guidelines and the evidence underpinning them and explores the rational for using antiplatelet and/or anticoagulant strategies after TAVI.

关 键 词：经导管主动脉瓣植入术 抗血小板治疗 抗凝血治疗 维生素K拮抗剂 新型口服抗凝药物 综述 

分 类 号：R654.2[医药卫生—外科学]