经导管主动脉瓣置换术(TAVR)的血液并发症:识别与治疗。

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiology in Review Pub Date : 2024-09-10 DOI:10.1097/CRD.0000000000000785
Sahil Bhargava, Darshilkumar Maheta, Siddharth Pravin Agrawal, Maharshi Raval, William H Frishman, Wilbert S Aronow
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引用次数: 0

摘要

经导管主动脉瓣置换术(TAVR)已成为严重主动脉瓣狭窄、手术风险高或无法手术的患者的重要干预手段。虽然 TAVR 是一种微创手术,但它与严重的血液学问题有关,其中最突出的是血栓形成和出血。导致这些并发症的因素有很多,如手术特点、患者合并症和抗凝管理技术。出血并发症可大可小,或危及生命。造成这些并发症的原因可能是血管通路部位的问题、抗凝药物或并发症,如肾功能不全和体弱。必须密切关注血红蛋白下降、明显出血和血肿征象,以识别出血。谨慎选择和调整抗凝药物、使用血管闭合装置以及及时关注出血部位都是管理技巧的范例。血栓形成的后果包括脑血管意外和瓣膜血栓形成,由内皮损伤、支架植入和患者高凝状态引起。计算机断层扫描和经食道超声心动图等成像模式用于检测的关键过程。预防性治疗的目标是根据每位患者的风险状况,最大限度地调整抗凝方案,经常在血栓形成和出血风险之间取得平衡。要有效控制这些血液并发症,必须采取多学科策略,整合外科、血液科和心脏科的专业知识。为了改善患者的预后,正在进行的研究试图改善风险分层并制定更安全的抗凝方案。本综述强调了尽快识别出血和血栓事件并及时治疗以降低 TAVR 患者不良预后风险的重要性。
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Hematological Complications From Transcatheter Aortic Valve Replacement (TAVR): Recognition and Treatment.

Transcatheter aortic valve replacement (TAVR) has emerged as a pivotal intervention for patients with severe aortic stenosis who are at high or prohibitive surgical risk. Although TAVR is a minimally invasive procedure, it is linked to serious hematological problems, most notably thrombosis and bleeding. Numerous factors, such as procedural features, patient comorbidities, and anticoagulation management techniques, contribute to these complications. Bleeding complications can be major, minor, or life-threatening. They can be caused by problems with the vascular access site, anticoagulation medication, or coexisting conditions like renal dysfunction and frailty. Hemoglobin drop, overt bleeding, and hematoma signs must all be closely watched to identify bleeding. Careful selection and modification of anticoagulation medication, the use of vascular closure devices, and timely attention to bleeding sites are examples of management techniques. Thrombotic consequences, which include cerebrovascular accidents and valve thrombosis, are caused by endothelial injury, stent implantation, and patient hypercoagulability. Imaging modalities such as computed tomography and transesophageal echocardiography are used in the crucial process of detection. The goal of preventive care is to maximize anticoagulation regimens that are customized to each patient's risk profile, frequently striking a balance between the risk of thrombosis and bleeding. A multidisciplinary strategy that integrates surgical, hematological, and cardiology expertise is necessary for the effective management of these hematological complications. To improve patient outcomes, ongoing research attempts to improve risk stratification and create safer anticoagulation protocols. This review emphasizes how critical it is to identify bleeding and thrombotic events as soon as possible and treat them promptly to reduce the risk of negative outcomes for TAVR patients.

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来源期刊
Cardiology in Review
Cardiology in Review CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.60
自引率
0.00%
发文量
76
审稿时长
>12 weeks
期刊介绍: The mission of Cardiology in Review is to publish reviews on topics of current interest in cardiology that will foster increased understanding of the pathogenesis, diagnosis, clinical course, prevention, and treatment of cardiovascular disorders. Articles of the highest quality are written by authorities in the field and published promptly in a readable format with visual appeal
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