循環器ジャーナル68巻4号

2020年10月発行

特集 抗血栓療法—日常臨床での疑問に応える Ⅴ．周術期・その他の抗血栓療法

TAVI周術期および術後の抗血栓療法は現在どうなっているか？

著者： 足立優也¹ 志村徹郎¹ 山本真功¹

所属機関： ¹豊橋ハートセンター循環器内科

ページ範囲：P.694 - P.701

Point
・TAVI後の抗血栓療法は，症例ごとに血栓形成リスクと出血リスクを考慮したうえで，慎重に決定されるべきである．
・至適抗血栓療法に関するエビデンスはいまだ十分とは言えず，現在進行している試験を含め，今後も新たな知見の蓄積が望まれる．

参考文献

1) Baumgartner H, Falk V, Bax JJ, et al:2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739-2791, 2017

2) Tsunaki T, Yamamoto M, Shimura T, et al:Silent Valsalva thrombus between the native Valsalva and balloon-expandable transcatheter heart valve:multicenter Japanese registry analysis. EuroIntervention 15:892-899, 2019

3) Latib A, Naganuma T, Abdel-Wahab M, et al:Treatment and clinical outcomes of transcatheter heart valve thrombosis. Circ Cardiovasc Interv 8:e001779, 2015

4) Chakravarty T, Søndergaard L, Friedman J, et al:Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves:An observational study. Lancet 389:2383-2392, 2017

5) Ishii K, Tada N, Miyasaka M, et al:Acute Myocardial Infarction Due to Prosthetic Valve Leaflet Thrombosis 15 Months After TAVR. JACC Cardiovasc Interv 12:e135-e136, 2019

6) Makkar RR, Fontana G, Søndergaard L:Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. N Engl J Med 374:1591-1592, 2016

7) Kille A, Hochholzer W:Axillary Artery Occlusion after TAVR. N Engl J Med 382:179, 2020

8) Nishimura RA, Otto CM, Bonow RO, et al: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 Practice Guidelines. J Am Coll Cardiol 63:e57-e185, 2014

9) Nishimura RA, Otto CM, Bonow RO, et al: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 70:252-289, 2017

10) Yanagisawa R, Hayashida K, Yamada Y, et al:Incidence, Predictors, and Mid-Term Outcomes of Possible Leaflet Thrombosis After TAVR. JACC Cardiovasc Imaging 10:1-11, 2017

11) Vollema EM, Kong WKF, Katsanos S, et al:Transcatheter aortic valve thrombosis:the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke. Eur Heart J 38:1207-1217, 2017

12) Ruile P, Minners J, Breitbart P, et al:Medium-Term Follow-Up of Early Leaflet Thrombosis After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 11:1164-1171, 2018

13) 日本循環器学会：2020年改訂版 弁膜症治療のガイドライン．2020

14) Dangas GD, Tijssen JGP, Wöhrle J, et al:A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med 382:120-129, 2020

15) Van Mieghem NM, Unverdorben M, Valgimigli M, et al:Edoxaban Versus standard of care and their effects on clinical outcomes in patients having undergone Transcatheter Aortic Valve Implantation in Atrial Fibrillation-Rationale and design of the ENVISAGE-TAVI AF trial. Am Heart J 205:63-69, 2018

16) Nijenhuis VJ, Brouwer J, Delewi R, et al:Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 382:1696-1707, 2020

17) Collet JP, Berti S, Cequier A, et al:Oral anti-Xa anticoagulation after trans-aortic valve implantation for aortic stenosis:The randomized ATLANTIS trial. Am Heart J 200:44-50, 2018

18) Dual Antiplatelet Therapy Versus Oral Anticoagulation for a Short Time to Prevent Cerebral Embolism After TAVI（AUREA）.　https://clinicaltrials.gov/ct2/show/NCT01642134

19) Rodés-Cabau J, Masson JB, Welsh RC, et al:Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve:The ARTE（Aspirin Versus Aspirin＋Clopidogrel Following Transcatheter Aortic Valve Implantation）Randomized Clinical Trial. JACC Cardiovasc Interv 10:1357-1365, 2017

20) Abdul-Jawad Altisent OAJ, Durand E, Muñoz-García AJ, et al:Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv 9:1706-1717, 2016

21) Geis NA, Kiriakou C, Chorianopoulos E, et al:Feasibility and safety of vitamin K antagonist monotherapy in atrial fibrillation patients undergoing transcatheter aortic valve implantation. EuroIntervention 12:2058-2066, 2017

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

23) Smith CR, Leon MB, Mack MJ, et al:Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. N Engl J Med 364:2187-2198, 2011

24) Leon MB, Smith CR, Mack M, et al:Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med 363:1597-1607, 2010

25) Hioki H, Watanabe Y, Kozuma K, et al:Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valveimplantation increases risk of bleeding. Heart 103:361-367, 2017

26) 日本循環器学会：冠動脈疾患患者における抗血栓療法．2020

27) Watanabe H, Domei T, Morimoto T, et al:Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI:The STOPDAPT-2 Randomized Clinical Trial. JAMA 321:2414-2427, 2019

28) Natsuaki M, Morimoto T, Yamamoto E, et al:One-year outcome of a prospective trial stopping dual antiplatelet therapy at 3 months after everolimus-eluting cobalt-chromium stent implantation:ShortT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent（STOPDAPT）trial. Cardiovasc Interv Ther 31:196-209, 2016

29) Shimura T, Yamamoto M, Takano M, et al:Extreme late-phase observation using coronary angioscopy until 7 years after sirolimus-eluting stent implantation. Coron Artery Dis 27:29-33, 2016

30) Imai M, Kadota K, Goto T, et al:Incidence, risk factors, and clinical sequelae of angiographic peri-stent contrast staining after sirolimus-eluting stent implantation. Circulation 123:2382-2391, 2011

31) Alfonso F, Pérez-Vizcayno MJ, Ruiz M, et al:Coronary aneurysms after drug-eluting stent implantation:clinical, angiographic, and intravascular ultrasound findings. J Am Coll Cardiol 53:2053-2060, 2009

32) Boersma LV, Schmidt B, Betts TR et al:Implant success and safety of left atrial appendage closure with the WATCHMAN device:peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 37:2465-2474, 2016

33) Honda Y, Yamawaki M, Araki M, et al:Impact of HAS-BLED score to predict trans femoral transcatheter aortic valve replacement outcomes. Catheter Cardiovasc Interv 92:1387-1396, 2018

34) Tsunaki T, Yamamoto M, Shimizu K, et al:Silent Massive Valsalva Thrombosis Identified on Contrast-Enhanced Multislice Computed Tomography Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 9:2454-2455, 2016

35) De Backer O, Dangas GD, Jilaihawi H, et al:Reduced Leaflet Motion after Transcatheter Aortic-Valve Replacement. N Engl J Med 382:130-139, 2020

36) Yanagisawa R, Tanaka M, Yashima F, et al:Early and Late Leaflet Thrombosis After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 12:e007349, 2019

37) Jose J, Sulimov DS, El-Mawardy M, et al:Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement:Incidence, Characteristics, and Treatment Outcomes. JACC Cardiovasc Interv 10:686-697, 2017

38) Kapadia S, Tuzcu EM, Svensson LG:Anatomy and Flow Characteristics of Neosinus:Important Consideration for Thrombosis of Transcatheter Aortic Valves. Circulation 136:1610-1612, 2017