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Journal of Geriatric Cardiology 2018年第1期15卷 66-75页

作者： Manolis Vavuranakis Konstantinos Kalogeras angelos michail kolokathis Dimitrios Vrachatis Nikolaos Magkoutis Gerasimos Siasos Euaggelos Oikonomou Maria Kariori Theodoros Papaioannou Maria Lavda Carmen Moldovan Ourania Katsarou Dimitrios Tousoulis The First Department of Cardiology Hippokration Hospital Medical School National & Kapodistrian University of Athens Ilioupoli Greece

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.

关键词： Antiplatelets Antithrombotic Bleeding Stroke Transcatheter aortic valve implantation

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