PDF(Pubmed)
Abstract：
UNASSIGNED: Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in the absence of long-term oral anticoagulation (OAC) indications in patients post-transcatheter aortic valve replacement (TAVR). The superiority of one method over the other remains controversial.
UNASSIGNED: Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity.
UNASSIGNED: Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45-1.01; P=0.05], cardiovascular death [RR:0.91; 95% CI:0.73-1.14; P=0.42], MI [RR:1.69; 95% CI:0.43-6.72; P=0.46], Stroke/TIA [RR:0.79; 95% CI:0.58-1.06; P=0.12], ischaemic stroke [RR:0.83; 95% CI:0.50-1.37; P=0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23-5.15; P=0.92], major bleeding [RR:0.79; 95% CI:0.51-1.21; P=0.28], minor bleeding [RR:1.09; 95% CI: 0.80-1.47; P=0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55-1.30; P=0.45], any bleeding [RR:0.98; 95% CI:0.83-1.15; P=0.78], and systemic embolism [RR:0.87; 95% CI:0.44-1.70; P=0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56-4.36; P =0.0002].
UNASSIGNED: Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.
UNASSIGNED: Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity.
UNASSIGNED: Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45-1.01; P=0.05], cardiovascular death [RR:0.91; 95% CI:0.73-1.14; P=0.42], MI [RR:1.69; 95% CI:0.43-6.72; P=0.46], Stroke/TIA [RR:0.79; 95% CI:0.58-1.06; P=0.12], ischaemic stroke [RR:0.83; 95% CI:0.50-1.37; P=0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23-5.15; P=0.92], major bleeding [RR:0.79; 95% CI:0.51-1.21; P=0.28], minor bleeding [RR:1.09; 95% CI: 0.80-1.47; P=0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55-1.30; P=0.45], any bleeding [RR:0.98; 95% CI:0.83-1.15; P=0.78], and systemic embolism [RR:0.87; 95% CI:0.44-1.70; P=0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56-4.36; P =0.0002].
UNASSIGNED: Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.
摘要：
■最近的指南建议，在经导管主动脉瓣置换术（TAVR）后没有长期口服抗凝（OAC）适应症的患者中，抗血小板治疗（APT）是治疗的标准。一种方法优于另一种方法仍然存在争议。
■几个数据库，包括MEDLINE,谷歌学者，和EMBASE,电子搜索。主要终点是全因死亡率（ACM）。次要终点包括心血管死亡，心肌梗死（MI），中风/TIA,出血性中风，出血事件,全身性栓塞,接受APT和口服抗凝剂（OAC）的TAVR后患者的瓣膜血栓形成。使用ReviewManager版本5.4生成森林地块，p值小于0.05，表明有统计学意义。进行亚组分析以探索异质性的潜在来源。
■选择了12项研究。APT和OAC组ACM无显著差异[风险比(RR):0.67;95%CI:0.45-1.01;P=0.05],心血管死亡[RR：0.91；95%CI：0.73-1.14；P=0.42]，MI[RR：1.69；95%CI：0.43-6.72；P=0.46]，卒中/TIA[RR:0.79;95%CI:0.58-1.06;P=0.12],缺血性卒中[RR：0.83；95%CI：0.50-1.37；P=0.47]，出血性卒中[RR：1.08；95%CI：0.23-5.15；P=0.92]，大出血[RR：0.79；95%CI：0.51-1.21；P=0.28]，轻微出血[RR：1.09；95%CI：0.80-1.47；P=0.58]，危及生命的出血[RR：0.85；95%CI：0.55-1.30；P=0.45]，任何出血[RR：0.98；95%CI：0.83-1.15；P=0.78]，和全身性栓塞[RR:0.87;95%CI:0.44-1.70;P=0.68]。接受APT的患者发生瓣膜血栓形成的风险高于接受OAC的患者[RR:2.61;95%CI:1.56-4.36;P=0.0002]。
■尽管接受APT的患者瓣膜血栓形成的风险增加，两组的其他终点风险相当.
■几个数据库，包括MEDLINE,谷歌学者，和EMBASE,电子搜索。主要终点是全因死亡率（ACM）。次要终点包括心血管死亡，心肌梗死（MI），中风/TIA,出血性中风，出血事件,全身性栓塞,接受APT和口服抗凝剂（OAC）的TAVR后患者的瓣膜血栓形成。使用ReviewManager版本5.4生成森林地块，p值小于0.05，表明有统计学意义。进行亚组分析以探索异质性的潜在来源。
■选择了12项研究。APT和OAC组ACM无显著差异[风险比(RR):0.67;95%CI:0.45-1.01;P=0.05],心血管死亡[RR：0.91；95%CI：0.73-1.14；P=0.42]，MI[RR：1.69；95%CI：0.43-6.72；P=0.46]，卒中/TIA[RR:0.79;95%CI:0.58-1.06;P=0.12],缺血性卒中[RR：0.83；95%CI：0.50-1.37；P=0.47]，出血性卒中[RR：1.08；95%CI：0.23-5.15；P=0.92]，大出血[RR：0.79；95%CI：0.51-1.21；P=0.28]，轻微出血[RR：1.09；95%CI：0.80-1.47；P=0.58]，危及生命的出血[RR：0.85；95%CI：0.55-1.30；P=0.45]，任何出血[RR：0.98；95%CI：0.83-1.15；P=0.78]，和全身性栓塞[RR:0.87;95%CI:0.44-1.70;P=0.68]。接受APT的患者发生瓣膜血栓形成的风险高于接受OAC的患者[RR:2.61;95%CI:1.56-4.36;P=0.0002]。
■尽管接受APT的患者瓣膜血栓形成的风险增加，两组的其他终点风险相当.
