- 作者：Chiara Bernelli ; Alaide Chieffo ; Matteo Montorfano ; Francesco Maisano ; Gennaro Giustino ; Gill Louise Buchanan ; Jaclyn Chan ; Charis Costopoulos ; Azeem Latib ; Filippo Figini ; Ermelinda De Meo ; Francesco Giannini ; Remo Daniel Covello ; Chiara Gerli ; Annalisa Franco ; Eustachio Agricola ; Pietro Spagnolo ; Micaela Cioni ; Ottavio Alfieri ; Paolo Guido Camici ; Antonio Colombo ; et al.
- 关键词：activated clotting time ; aortic stenosis ; bleeding ; transcatheter aortic valve implantation
- 刊名：JACC: Cardiovascular Interventions
- 出版年：February, 2014
- 年：2014
- 卷：7
- 期：2
- 页码：140-151
- 全文大小：1126 K
Objectives
This study sought to evaluate the impact of baseline activated clotting time (ACT)-guided heparin administration on major bleeding after transfemoral transcatheter aortic valve implantation (TAVI).Background
Bleeding after TAVI is frequent and associated with unfavorable prognosis. Proper intraprocedural heparin dose administration may reduce the risk of potential overdosing in this frail study group.
Methods
Of the patients who underwent transfemoral TAVI in our center from November 1, 2007 to聽June 31, 2012, 362 were retrospectively analyzed. Because abnormally high baseline ACT values were noted, heparin was administered at the operator's discretion, according to baseline ACT (ACT-guided, n聽= 174) or patient's body weight (non-ACT-guided, n聽= 188). The primary study objective was 30-day major bleeding as defined by the Valve Academic Research Consortium criteria. Secondary objectives were any life-threatening, and minor bleeding, and other Valve Academic Research Consortium outcomes at 30 days.
Results
Bleeding occurred in 167 (46.1%) patients; of these, 76 (21.0%) had major bleeding. The ACT-guided group had a significantly lower occurrence of major (7.5% vs. 33.5%, p < 0.001), life-threatening (12.1% vs. 20.2%, p聽= 0.04), and any bleeding (25.9% vs. 64.9%, p < 0.001). Conversely, no differences were noted in the other study objectives. After adjustment for potential confounders, the protective odds ratio for ACT-guided therapy on major bleeding was 6.4 (95% confidence interval: 2.3 to 17.9; p < 0.001) at 30 days.
Conclusions
In our experience, heparin administration according to baseline ACT was correlated with a significantly lower occurrence of major bleeding in transfemoral TAVI. This strategy might be a useful tool in reducing bleeding in this high-risk study group.