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16.11.2017 | Embolieprophylaxe und Antikoagulation | Schwerpunkt

Antithrombozytäre oder antikoagulative Strategie nach chirurgischer/interventioneller Klappenbehandlung

verfasst von: Dr. med. A. Jobs, Dr. med. T. Stiermaier, Prof. Dr. med. S. Klotz, PD Dr. med. I. Eitel

Erschienen in: Herz | Ausgabe 1/2018

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Zusammenfassung

Ende August 2017 publizierte die europäische kardiologische Gesellschaft (European Society of Cardiology, ESC) gemeinsam mit der europäischen Gesellschaft für Herz- und thorakale Gefäßchirurgie (European Association for Cardio-Thoracic Surgery, EACTS) neue Leitlinien zur Behandlung von Klappenerkrankungen. Diese Leitlinien berücksichtigen neue wissenschaftliche Erkenntnisse, die seit der letzten Leitlinienversion 2012 verfügbar sind. Diese Übersichtsarbeit berichtet über die aktuellen Empfehlungen zur antithrombozytären und antikoagulativen Therapie nach chirurgischer/interventioneller Behandlung der Aorten- und Mitralklappe und diskutiert die zugrunde liegende wissenschaftliche Evidenz.

Holmes DR, Mack MJ (2017) Aortic valve bioprostheses: leaflet immobility and valve thrombosis. Circulation 135(18):1749–1756. https://doi.org/10.1161/CIRCULATIONAHA.116.025429 CrossRefPubMed

Baumgartner H, Falk V, Bax JJ et al (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease: The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. https://doi.org/10.1093/eurheartj/ehx391

Beckmann A, Funkat AK, Lewandowski J et al (2017) German Heart Surgery Report 2016: the annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg. https://doi.org/10.1055/s-0037-1606603

Sun JC, Davidson MJ, Lamy A, Eikelboom JW (2009) Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends. Lancet 374(9689):565–576. https://doi.org/10.1016/S0140-6736(09)60780-7 CrossRefPubMed

Reinohl J, Kaier K, Reinecke H et al (2015) Effect of availability of transcatheter aortic-valve replacement on clinical practice. N Engl J Med 373(25):2438–2447. https://doi.org/10.1056/NEJMoa1500893 CrossRefPubMed

Cribier A, Eltchaninoff H, Bash A et al (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106(24):3006–3008CrossRefPubMed

Smith CR, Leon MB, Mack MJ et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198. https://doi.org/10.1056/NEJMoa1103510 CrossRefPubMed

Leon MB, Smith CR, Mack MJ et al (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374(17):1609–1620. https://doi.org/10.1056/NEJMoa1514616 CrossRefPubMed

Reardon MJ, Van Mieghem NM, Popma JJ et al (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 376(14):1321–1331. https://doi.org/10.1056/NEJMoa1700456 CrossRefPubMed

10.

Dangas GD, Weitz JI, Giustino G et al (2016) Prosthetic heart valve thrombosis. J Am Coll Cardiol 68(24):2670–2689. https://doi.org/10.1016/j.jacc.2016.09.958 CrossRefPubMed

11.

Grunkemeier GL, Wu Y (2003) “Our complication rates are lower than theirs”: statistical critique of heart valve comparisons. J Thorac Cardiovasc Surg 125(2):290–300. https://doi.org/10.1067/mtc.2003.53 CrossRefPubMed

12.

Xu Z, Wang ZP, Ou JS et al (2016) Is low anticoagulation intensity more beneficial for patients with bileaflet mechanical mitral valves? A meta-analysis. J Cardiovasc Surg (Torino) 57(1):90–99

13.

Yanagawa B, Whitlock RP, Verma S, Gersh BJ (2016) Anticoagulation for prosthetic heart valves: unresolved questions requiring answers. Curr Opin Cardiol 31(2):176–182. https://doi.org/10.1097/HCO.0000000000000259 CrossRefPubMed

14.

Cannegieter SC, Rosendaal FR, Briet E (1994) Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89(2):635–641CrossRefPubMed

15.

Mok CK, Boey J, Wang R et al (1985) Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial. Circulation 72(5):1059–1063CrossRefPubMed

16.

Cannegieter SC, Rosendaal FR, Wintzen AR et al (1995) Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 333(1):11–17. https://doi.org/10.1056/NEJM199507063330103 CrossRefPubMed

17.

Hering D, Piper C, Bergemann R et al (2005) Thromboembolic and bleeding complications following St. Jude Medical valve replacement: results of the German Experience With Low-Intensity Anticoagulation Study. Chest 127(1):53–59. https://doi.org/10.1378/chest.127.1.53 CrossRefPubMed

18.

Acar J, Iung B, Boissel JP et al (1996) AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves. Circulation 94(9):2107–2112CrossRefPubMed

19.

Puskas J, Gerdisch M, Nichols D et al (2014) Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial. J Thorac Cardiovasc Surg 147(4):1202–1211. https://doi.org/10.1016/j.jtcvs.2014.01.004 CrossRefPubMed

20.

Eikelboom JW, Connolly SJ, Brueckmann M et al (2013) Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 369(13):1206–1214. https://doi.org/10.1056/NEJMoa1300615 CrossRefPubMed

21.

Nishimura RA, Otto CM, Bonow RO et al (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 70(2):252–289. https://doi.org/10.1016/j.jacc.2017.03.011 CrossRefPubMed

22.

Vahanian A, Alfieri O, Andreotti F et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496. https://doi.org/10.1093/eurheartj/ehs109 CrossRefPubMed

23.

Massel DR, Little SH (2013) Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev 7:CD3464. https://doi.org/10.1002/14651858.CD003464.pub2

24.

Turpie AG, Gent M, Laupacis A et al (1993) A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med 329(8):524–529. https://doi.org/10.1056/NEJM199308193290802 CrossRefPubMed

25.

Valgimigli M, Bueno H, Byrne RA et al (2017) 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. https://doi.org/10.1093/eurheartj/ehx419

26.

Heras M, Chesebro JH, Fuster V et al (1995) High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol 25(5):1111–1119CrossRefPubMed

27.

Turpie AG, Gunstensen J, Hirsh J et al (1988) Randomised comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet 1(8597):1242–1245CrossRefPubMed

28.

Aramendi JI, Mestres CA, Martinez-Leon J et al (2005) Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (trac): prospective, randomized, co-operative trial. Eur J Cardiothorac Surg 27(5):854–860. https://doi.org/10.1016/j.ejcts.2004.12.064 CrossRefPubMed

29.

Colli A, Mestres CA, Castella M, Gherli T (2007) Comparing warfarin to aspirin (WoA) after aortic valve replacement with the St. Jude Medical Epic heart valve bioprosthesis: results of the WoA Epic pilot trial. J Heart Valve Dis 16(6):667–671PubMed

30.

Merie C, Kober L, Skov Olsen P et al (2012) Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. JAMA 308(20):2118–2125. https://doi.org/10.1001/jama.2012.54506 CrossRefPubMed

31.

Toeg HD, Bjerre LM, Ruel M (2013) Warfarin treatment after bioprosthetic aortic valve replacement. JAMA 309(12):1225. https://doi.org/10.1001/jama.2013.1972 CrossRefPubMed

32.

Colli A, Verhoye JP, Heijmen R et al (2013) Low-dose acetyl salicylic acid versus oral anticoagulation after bioprosthetic aortic valve replacement. Final report of the ACTION registry. Int J Cardiol 168(2):1229–1236. https://doi.org/10.1016/j.ijcard.2012.11.056 CrossRefPubMed

33.

Bourget JM, Zegdi R, Lin J et al (2017) Correlation between structural changes and acute thrombogenicity in transcatheter pericardium valves after crimping and balloon deployment. Morphologie 101(332):19–32. https://doi.org/10.1016/j.morpho.2016.06.003 CrossRefPubMed

34.

Chakravarty T, Sondergaard L, Friedman J et al (2017) Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet 389(10087):2383–2392. https://doi.org/10.1016/S0140-6736(17)30757-2 CrossRefPubMed

35.

Hansson NC, Grove EL, Andersen HR et al (2016) Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications. J Am Coll Cardiol 68(19):2059–2069. https://doi.org/10.1016/j.jacc.2016.08.010 CrossRefPubMed

36.

Makkar RR, Fontana G, Jilaihawi H et al (2015) Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med 373(21):2015–2024. https://doi.org/10.1056/NEJMoa1509233 CrossRefPubMed

37.

Pache G, Schoechlin S, Blanke P et al (2016) Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves. Eur Heart J 37(28):2263–2271. https://doi.org/10.1093/eurheartj/ehv526 CrossRefPubMed

38.

Ruile P, Jander N, Blanke P et al (2017) Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation. Clin Res Cardiol 106(2):85–95. https://doi.org/10.1007/s00392-016-1052-3 CrossRefPubMed

39.

Yanagisawa R, Hayashida K, Yamada Y et al (2016) Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVR. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2016.11.005

40.

Abdul-Jawad Altisent O, Durand E, Munoz-Garcia AJ et al (2016) Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv 9(16):1706–1717. https://doi.org/10.1016/j.jcin.2016.06.025 CrossRefPubMed

41.

Feldman T, Foster E, Glower DD et al (2011) Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 364(15):1395–1406. https://doi.org/10.1056/NEJMoa1009355 CrossRefPubMed

42.

Boekstegers P, Hausleiter J, Baldus S et al (2013) Interventionelle Behandlung der Mitralklappeninsuffizienz mit dem MitraClip®-Verfahren. Kardiologe 7(2):91–104. https://doi.org/10.1007/s12181-013-0492-5 CrossRef

43.

Maisano F, Franzen O, Baldus S et al (2013) Percutaneous mitral valve interventions in the real world: early and 1‑year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 62(12):1052–1061. https://doi.org/10.1016/j.jacc.2013.02.094 CrossRefPubMed

44.

Nickenig G, Estevez-Loureiro R, Franzen O et al (2014) Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1‑year follow-up of 628 patients of the 2011–2012 Pilot European Sentinel Registry. J Am Coll Cardiol 64(9):875–884. https://doi.org/10.1016/j.jacc.2014.06.1166 CrossRefPubMed

45.

Puls M, Lubos E, Boekstegers P, von Bardeleben RS et al (2016) One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J 37(8):703–712. https://doi.org/10.1093/eurheartj/ehv627 CrossRefPubMed

46.

Scandura S, Capranzano P, Caggegi A et al (2016) Percutaneous mitral valve repair with the MitraClip system in the elderly: one-year outcomes from the GRASP registry. Int J Cardiol 224:440–446. https://doi.org/10.1016/j.ijcard.2016.09.076 CrossRefPubMed

47.

Sorajja P, Mack M, Vemulapalli S et al (2016) Initial experience with commercial transcatheter mitral valve repair in the United States. J Am Coll Cardiol 67(10):1129–1140. https://doi.org/10.1016/j.jacc.2015.12.054 CrossRefPubMed

48.

Adams DH, Popma JJ, Reardon MJ et al (2014) Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 370(19):1790–1798. https://doi.org/10.1056/NEJMoa1400590 CrossRefPubMed

49.

Thyregod HG, Steinbruchel DA, Ihlemann N et al (2015) Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1‑year results from the All-Comers NOTION randomized clinical trial. J Am Coll Cardiol 65(20):2184–2194. https://doi.org/10.1016/j.jacc.2015.03.014 CrossRefPubMed

50.

Deutschen Gesellschaft für Kardiologie e. V. (2012) ESC Pocket Guidelines Herzklappenerkrankungen, Version 2012

Titel: Antithrombozytäre oder antikoagulative Strategie nach chirurgischer/interventioneller Klappenbehandlung
verfasst von: Dr. med. A. Jobs
Dr. med. T. Stiermaier
Prof. Dr. med. S. Klotz
PD Dr. med. I. Eitel
Publikationsdatum: 16.11.2017
Verlag: Springer Medizin
Schlagwörter: Embolieprophylaxe und Antikoagulation
Erkrankungen des Endokards und der Herzklappen
Herzchirurgie
Herzchirurgie
Erschienen in: Herz / Ausgabe 1/2018
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-017-4646-2

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