Antithrombotic Treatment After Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Procedures: A Systematic Review and Meta-Analysis.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Acta medica portuguesa Pub Date : 2025-09-01 Epub Date: 2025-07-21 DOI:10.20344/amp.22905
Gonçalo Terleira Batista, Gonçalo Costa, Joana Delgado Silva, Lino Gonçalves
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引用次数: 0

Abstract

Introduction: While antithrombotic therapy following transcatheter valve implantation has been extensively studied in various clinical trials, there remains a notable gap in evidence regarding the optimal approach following valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) procedures, warranting further assessment. This gap is particularly concerning due to the apparent increased risk of thrombosis associated with ViV interventions. The aim of this systematic review was to explore the potential benefits of anticoagulation in ViV, ViR, and ViMAC procedures.

Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, as well as the grey literature, for observational and interventional studies published until December 2023. Trials were included if a comparative analysis between the two antithrombotic strategies was feasible and excluded if patients under 18 years old were analysed. The primary efficacy endpoints were incidence of clinical and total valve thrombosis (VT), major bleeding was the sole safety primary endpoint. Additional analyses were performed regarding valves in the mitral position and valve type. The risk of bias was evaluated using the Newcastle-Ottawa scale. Data was assessed using the Review Manager 5.4 software.

Results: A total of five observational and one case series were included (n = 614 on anticoagulation and n = 468 on antiplatelets), comprising a total of 1082 participants. Clinical VT rates were 4.2% for all procedures, and patients on anticoagulants were associated with a a lower risk of clinical VT (1.1% vs 8.3%; OR: 0.18; 95% CI: 0.07 - 0.42, I2: 0%) and total VT (1.3% vs 8.5%; OR: 0.16; 95% CI: 0.07 - 0.37, I2: 0%). Regarding bleeding events, the existing literature did not provide adequate information to enable a thorough analysis.

Conclusion: Our study suggests a potential benefit of anticoagulation regimens to decrease the high rates of VT following valve-in-valve, valve-in-ring and valve-in-mitral annular calcification procedures. However, the lack of randomized controlled trials and data on bleeding and mortality emphasises the necessity for further research.

瓣膜中瓣、环中瓣和mac中瓣手术后的抗血栓治疗:系统回顾和荟萃分析。
导论:虽然经导管瓣膜植入后的抗血栓治疗已经在各种临床试验中得到了广泛的研究,但在瓣膜内(ViV)、瓣膜内环(ViR)和二尖瓣内环钙化(ViMAC)手术后的最佳方法方面,证据仍然存在明显的差距,需要进一步评估。由于体外注射干预明显增加了血栓形成的风险,这一差距尤其令人担忧。本系统综述的目的是探讨抗凝在ViV、ViR和ViMAC手术中的潜在益处。方法:我们检索PubMed、Embase和Cochrane中央对照试验注册库,以及灰色文献,检索截至2023年12月发表的观察性和干预性研究。如果两种抗血栓策略之间的比较分析是可行的,则纳入试验,如果分析的是18岁以下的患者,则排除试验。主要疗效终点是临床和全瓣膜血栓形成(VT)的发生率,大出血是唯一的安全性主要终点。进一步分析二尖瓣位置和瓣膜类型。偏倚风险采用纽卡斯尔-渥太华量表进行评估。使用Review Manager 5.4软件评估数据。结果:共纳入5个观察性和1个病例系列(抗凝治疗组n = 614,抗血小板治疗组n = 468),共1082名参与者。所有手术的临床VT率为4.2%,使用抗凝剂的患者的临床VT风险较低(1.1% vs 8.3%;OR: 0.18;95% CI: 0.07 - 0.42, I2: 0%)和总VT (1.3% vs 8.5%;OR: 0.16;95% ci: 0.07 - 0.37, i2: 0%)。关于出血事件,现有文献没有提供足够的信息来进行彻底的分析。结论:我们的研究表明抗凝治疗方案对降低瓣内、瓣内环和瓣内二尖瓣环形钙化手术后的高VT率具有潜在的益处。然而,缺乏关于出血和死亡率的随机对照试验和数据强调了进一步研究的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta medica portuguesa
Acta medica portuguesa MEDICINE, GENERAL & INTERNAL-
CiteScore
1.90
自引率
16.70%
发文量
256
审稿时长
6-12 weeks
期刊介绍: The aim of Acta Médica Portuguesa is to publish original research and review articles in biomedical areas of the highest standard, covering several domains of medical knowledge, with the purpose to help doctors improve medical care. In order to accomplish these aims, Acta Médica Portuguesa publishes original articles, review articles, case reports and editorials, among others, with a focus on clinical, scientific, social, political and economic factors affecting health. Acta Médica Portuguesa will be happy to consider manuscripts for publication from authors anywhere in the world.
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