Antithrombotische Therapie nach perkutanen Klappeninterventionen

Perkutane Klappeninterventionen wie beispielsweise der interventionelle Aortenklappenersatz oder die Implantation von Anuloplastieringen stellen mittlerweile Standardeingriffe in der Kardiologie dar. Da die meisten für solche Eingriffe infrage kommenden Patienten sowohl ein hohes thromboembolisches bzw. ischämisches Risiko als auch ein hohes Blutungsrisiko aufweisen, kann die Wahl der optimalen Gerinnungstherapie eine Herausforderung darstellen.

Schlüsselwörter

antithrombotische Therapie - strukturelle kardiale Intervention - TAVI - MitraClip - Okkluder

• Literatur

• 1 Hochholzer W, Nührenberg T, Flierl U. et al. Antithrombotische Therapie nach strukturellen kardialenInterventionen. Empfehlung der Arbeitsgruppe Kardiovaskuläre Hämostase und Antithrombotische Therapie (AG19) der Deutschen Gesellschaft für Kardiologie – Herz- undKreislaufforschung e. V. (DGK) in Zusammenarbeit mit der Arbeitsgruppe Interventionelle Kardiologie (AG6) – AGIK und der Arbeitsgruppe Klinische Pharmakologie (AG22) der DGK. Kardiologe 2021; 15: 57-70
• 2 Brouwer J, Nijenhuis VJ, Delewi R. et al. Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 383: 1447-1457
• 3 Dangas GD, Tijssen JGP, Wohrle J. et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement. N Engl J Med 2020; 382: 120-129
• 4 Nijenhuis VJ, Brouwer J, Delewi R. et al. Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 382: 1696-1707
• 5 Ten Berg J, Sibbing D, Rocca B. et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J 2021; 42: 2265-2269
• 6 Urban P, Mehran R, Colleran R. et al. Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention. Circulation 2019; 140: 240-261
• 7 Baumgartner H, Falk V, Bax JJ. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38: 2739-2791
• 8 Ruile P, Minners J, Breitbart P. et al. Medium-Term Follow-Up of Early Leaflet Thrombosis After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11: 1164-1171
• 9 Makki N, Shreenivas S, Kereiakes D. et al. A meta-analysis of reduced leaflet motion for surgical and transcatheter aortic valves: Relationship to cerebrovascular events and valve degeneration. Cardiovasc Revasc Med 2018; 19: 868-873
• 10 Kille A, Hochholzer W. Axillary Artery Occlusion after TAVR. N Engl J Med 2020; 382: 179
• 11 Chakravarty T, Sondergaard L, Friedman J. et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet 2017; 389: 2383-2392
• 12 Collet J. Anti-Thrombotic Strategy to Lower All cardiovascular and Neurologic Ischemic and Hemorrhagic Events after Trans-Aortic Valve Implantation for Aortic Stenosis – ATLANTIS, oral presentation at the American College of Cardiology Virtual Annual Scientific Session (ACC 2021), May 15, 2021. Im Internet (Stand: 22.08.2021): https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2021/05/14/01/58/ATLANTIS
• 13 Van Mieghem NM, Unverdorben M, Hengstenberg C. et al. Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR. N Engl J Med 2021;
• 14 Stone GW, Lindenfeld J, Abraham WT. et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 2018; 379: 2307-2318
• 15 Obadia J-F, Messika-Zeitoun D, Leurent G. et al. Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation. N Engl J Med 2018; 379: 2297-2306
• 16 Eggebrecht H, Schelle S, Puls M. et al. Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv 2015; 86: 728-735
• 17 Geisler T, Jorbenadze R, Popov AF. et al. Thrombogenicity and Antithrombotic Strategies in Structural Heart Interventions and Nonaortic Cardiac Device Therapy-Current Evidence and Practice. Thromb Haemost 2019; 19: 1590-1605
• 18 Del Val D, Ferreira-Neto AN, Wintzer-Wehekind J. et al. Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2019; 8: e013332
• 19 Seeger J, Markovic S, Kessler M. et al. Apixaban After Percutaneous Edge-to-Edge Mitral Valve Repair in Patients With Maintained Sinus Rhythm. JACC Cardiovasc Interv 2019; 12: 214-216
• 20 Dukkipati SR, Kar S, Holmes DR. et al. Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. Circulation 2018; 138: 874-885
• 21 Pracon R, Bangalore S, Dzielinska Z. et al. Device Thrombosis After Percutaneous Left Atrial Appendage Occlusion Is Related to Patient and Procedural Characteristics but Not to Duration of Postimplantation Dual Antiplatelet Therapy. Circ Cardiovasc Interv 2018; 11: e005997
• 22 Sedaghat A, Schrickel JW, Andrie R. et al. Thrombus Formation After Left Atrial Appendage Occlusion With the Amplatzer Amulet Device. JACC Clin Electrophysiol 2017; 3: 71-75