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- Title
Optimal antiplatelet and antithrombotic regimen post‐transcatheter aortic valve replacement.
- Authors
Moey, Melissa Y. Y.; Udani, Kunjan; Nifong, L. Wiley; Carabello, Blase A.; Morris, D. Lynn; Shah, Neeraj N.
- Abstract
Background: There are limited data regarding optimal antiplatelet/antithrombotic therapy following transcatheter aortic valve replacement (TAVR). Methods: In this single‐centre retrospective study including TAVR patients from 2012 to 2020, ischemic and bleeding outcomes were compared between antiplatelet (dual antiplatelet [DAPT] vs. single antiplatelet [SAPT]) and oral anticoagulation (OAC) groups using incidence rate, Kaplan–Meier and Cox proportional hazards analysis. Results: Total 492 patients (mean age 79.7 ± 7.7 years, 53.7% males, 83.5% Caucasian) were included. There was higher incidence of 1‐year death or ischemia with DAPT vs. SAPT (23.6 vs. 14.8 per 100 patient‐years [PY], incidence rate ratio [IRR] 1.60, 95% confidence interval [CI] 0.97–2.68, p =.05), especially in those without coronary artery disease (23.9 vs. 10.7 per 100 PY, IRR 2.24, 95% CI 1.10–4.47, p =.017). There was significantly higher major bleeding in those on OAC vs. no OAC (15 vs. 8 per 100 PY, IRR 1.87, 95% CI 1.10–3.11, p =.016), especially late (>1‐year) bleeding (10.2 vs. 3.6 per 100 PY, IRR 2.81, 95% CI 1.33–5.92, p =.004). In multivariate analysis, DAPT was an independent predictor of death or ischemia (adjusted hazard ratio [aHR] 1.41, 95% CI 1.01–1.96, p =.041). OAC was an independent predictor of major bleeding (aHR 2.32, 95% CI 1.31–4.13, p =.004). Conclusions: There is signal to harm with routine use of DAPT post‐TAVR. There is higher incidence of late bleeding post‐TAVR with OAC, suggesting potential role for alternate antithrombotic strategies.
- Subjects
AORTIC valve transplantation; HEART valve prosthesis implantation; FIBRINOLYTIC agents; CORONARY artery disease
- Publication
European Journal of Clinical Investigation, 2023, Vol 53, Issue 12, p1
- ISSN
0014-2972
- Publication type
Article
- DOI
10.1111/eci.14071