Can TAVI patients receive aspirin monotherapy as patients after surgical aortic bioprosthesis implantation? Data from the Polish Registry — POL-TAVI

Czerwińska-Jelonkiewicz, Katarzyna; Zembala, Marian; Dąbrowski, M; Witkowski, Adam; Ochała, Andrzej; Kochman, Janusz; Dudek, Dariusz; Kübler, Piotr; Jagielak, Dariusz; Stępińska, Janina

doi:10.1016/j.ijcard.2016.11.095

Cited by 30 publications

(20 citation statements)

References 17 publications

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“…Taking into account patient’s age and the current situation that the incidence of life-threatening bleeding is high at 10%–15%,27 the use of antithrombotic drugs should be minimised. There are several retrospective studies showing that single antiplatelet therapy may be an acceptable treatment compared with DAPT in elderly patients at high risk of bleeding 25. A recent prospective randomised study (Aspirin Versus Aspirin+ClopidogRel Following Transcatheter Aortic Valve Implantation, NCT01559298 and NCT02640794) also showed aspirin alone reduced the risk for major or life-threatening events while not increasing the risk for myocardial infarction or stroke 24.…”

Section: Treatmentmentioning

confidence: 99%

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Nakatani

2017

Heart

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Although clinically significant valve thrombosis after transcatheter aortic valve implantation (TAVI) is rare, the incidence of subclinical leaflet thrombosis has been reported to be up to about 10%-15%. It is mostly found 1-3 months after procedure in any type of transcatheter heart valve. Leaflet thrombosis is detected by high-resolution CT in the form of limited valve opening/closure and hypoattenuated leaflet thickening. Transthoracic or transesophageal echocardiography is capable of detecting limitations of valve motion, leaflet thickening, increased flow velocity across the valve. However, CT seems to be more sensitive than echocardiography to detect leaflet thrombosis. It can occur under dual antiplatelet therapy with aspirin and a thienopyridine but rarely occurs with anticoagulation with a vitamin K antagonist. A vitamin K antagonist is also helpful to resolve leaflet thrombosis. Several studies are ongoing to determine the effect of new oral anticoagulants (NOACs) in preventing major cardiovascular events. They will also provide useful information on whether NOACs prevent leaflet thrombosis.

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Section: Treatmentmentioning

confidence: 99%

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Nakatani

2017

Heart

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“…However, no significant discrepancies in the incidence of MI and stroke were found. Czerwińska-Jelonkiewicz et al [28] found that aspirin after TAVI significantly reduced the risk of vascular complications and bleeding with no adverse impact on efficacy endpoints in comparison to other strategies. Sterling et al[29] revealed a trend towards an increased incidence of major/life-threatening bleeding when comparing DAPT to SAPT, with similar rates of stoke and death.…”

Section: Discussionmentioning

confidence: 99%

Single versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Yang

Wang

et al. 2018

Cardiology

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Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is currently recommended in patients after transcatheter aortic valve implantation (TAVI), this practice is not supported by sufficient evidence. This study was performed to compare DAPT to single antiplatelet therapy (SAPT). Methods: An electronic search was completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane Central Register of Controlled Trials. Studies comparing DAPT versus SAPT in patients undergoing TAVI were included. Results: Seven studies incorporating 1,445 patients were eligible for the present meta-analysis. There were no significant differences on 30-day all-cause mortality (OR 1.19, 95% CI 0.63–2.25, p = 0.593), 6-month all-cause mortality (OR 1.11, 95% CI 0.49–2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95% CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for 30-day (OR 2.91, 95% CI 1.85–4.58, p < 0.01), 6-month (OR 2.54, 95% CI 1.26–5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95% CI 1.04–6.77, p = 0.041) based on 896, 337, and 583 patients, respectively, compared to SAPT. Conclusion: Compared to SAPT, DAPT was not shown to be superior in reducing thrombotic events, but presented an increased risk of major/life-threatening bleeding. More randomized controlled trials are needed to provide further evidence.

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“…Based on reports of high bleeding rates in patients undergoing TAVI in Poland, its authors recommend individual evaluation of double antiplatelet therapy (DAPT) requirements vs. single antiplatelet therapy (SAPT). They also note that antiplatelet monotherapy, preferably with aspirin, could minimise bleeding complications, without increasing rates of early dysfunction of TAVI bioprosthesis [118,119]. In patients with indications to OAC, we recommend a combination of OAC and SAPT (clopidogrel or aspirin) for 1-3 months [13, 14, 17-19, 83, 101, 120].…”

Section: Bioprosthetic Transcatheter Valve Dysfunctionmentioning

confidence: 99%