open access

Vol 24, No 6 (2017)
Original articles — Clinical cardiology
Published online: 2017-04-27
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Comparison of dual antiplatelet therapy versus oral anticoagulation following transcatheter aortic valve replacement: A retrospective single-center registry analysis

Erik W. Holy, Julia Kebernik, Abdelhakim Allali, Mohamed El-Mawardy, Gert Richardt, Mohamed Abdel-Wahab
DOI: 10.5603/CJ.a2017.0050
·
Pubmed: 28497845
·
Cardiol J 2017;24(6):649-659.

open access

Vol 24, No 6 (2017)
Original articles — Clinical cardiology
Published online: 2017-04-27

Abstract

Background: The choice of optimal antithrombotic regimen after transcatheter aortic valve replace-ment (TAVR) remains a matter of debate. The objective of this study was to compare both efficacy and safety outcomes based on the type of antithrombotic therapy prescribed after TAVR Methods: This is a retrospective analysis of 514 consecutive patients treated with either dual antiplate¬let therapy (DAPT) (n = 315; 61.3%) or oral anticoagulation (OAC) plus clopidogrel (n = 199; 38.7%) for a minimum of 3 months after TAVR followed by antiplatelet monotherapy or OAC only, respectively. Patients had pre-defined clinical and echocardiographic follow-ups at 30 days, 6 and 12 months. The key efficacy endpoint was a composite of all-cause death, myocardial infarction, stroke and valve throm¬bosis at 1 year. The key safety endpoint was the occurrence of life-threatening/major bleeding at 1 year. Results: Baseline characteristics did not differ between both groups, except for a higher incidence of atrial fibrillation in the OAC group. No significant differences in both efficacy and safety endpoints were observed at 30 days and 6 months. At 1 year, the key efficacy endpoint occurred in 21.5% of the DAPT group compared to 19.7% of the OAC group (p = 0.61). The key safety endpoint occurred in 25.1% and 27.8%, respectively (p = 0.53). However, after 1 year valve thrombosis was reported in 8 (2.5%) patients in the DAPT group but not in the OAC group (p = 0.02). Conclusions: OAC after TAVR seems to reduce the risk of clinical valve thrombosis without a statisti-cally significant increase in bleeding complications.

Abstract

Background: The choice of optimal antithrombotic regimen after transcatheter aortic valve replace-ment (TAVR) remains a matter of debate. The objective of this study was to compare both efficacy and safety outcomes based on the type of antithrombotic therapy prescribed after TAVR Methods: This is a retrospective analysis of 514 consecutive patients treated with either dual antiplate¬let therapy (DAPT) (n = 315; 61.3%) or oral anticoagulation (OAC) plus clopidogrel (n = 199; 38.7%) for a minimum of 3 months after TAVR followed by antiplatelet monotherapy or OAC only, respectively. Patients had pre-defined clinical and echocardiographic follow-ups at 30 days, 6 and 12 months. The key efficacy endpoint was a composite of all-cause death, myocardial infarction, stroke and valve throm¬bosis at 1 year. The key safety endpoint was the occurrence of life-threatening/major bleeding at 1 year. Results: Baseline characteristics did not differ between both groups, except for a higher incidence of atrial fibrillation in the OAC group. No significant differences in both efficacy and safety endpoints were observed at 30 days and 6 months. At 1 year, the key efficacy endpoint occurred in 21.5% of the DAPT group compared to 19.7% of the OAC group (p = 0.61). The key safety endpoint occurred in 25.1% and 27.8%, respectively (p = 0.53). However, after 1 year valve thrombosis was reported in 8 (2.5%) patients in the DAPT group but not in the OAC group (p = 0.02). Conclusions: OAC after TAVR seems to reduce the risk of clinical valve thrombosis without a statisti-cally significant increase in bleeding complications.
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Keywords

oral anticoagulation, platelet aggregation inhibitors, transcatheter aortic valve replacement, valve thrombosis

About this article
Title

Comparison of dual antiplatelet therapy versus oral anticoagulation following transcatheter aortic valve replacement: A retrospective single-center registry analysis

Journal

Cardiology Journal

Issue

Vol 24, No 6 (2017)

Pages

649-659

Published online

2017-04-27

DOI

10.5603/CJ.a2017.0050

Pubmed

28497845

Bibliographic record

Cardiol J 2017;24(6):649-659.

Keywords

oral anticoagulation
platelet aggregation inhibitors
transcatheter aortic valve replacement
valve thrombosis

Authors

Erik W. Holy
Julia Kebernik
Abdelhakim Allali
Mohamed El-Mawardy
Gert Richardt
Mohamed Abdel-Wahab

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