Clinical Outcomes and Bioprosthetic Valve Function After Transcatheter Aortic Valve Implantation Under Dual Antiplatelet Therapy vs. Aspirin Alone

Ichibori, Yasuhiro; Mizote, Isamu; Maeda, Koichi; Onishi, Toshinari; Ohtani, Tomohito; Yamaguchi, Osamu; Torikai, Kei; Kuratani, Toru; Sawa, Yoshiki; Nakatani, Satoshi; Sakata, Yasushi

doi:10.1253/circj.cj-16-0903

Cited by 46 publications

(38 citation statements)

References 25 publications

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“…A higher rate of major or life-threatening bleeding in DAPT (21%) than SAPT (8%) was found in a smaller single-centre study (n=144) 13. In the Aspirin Versus Aspirin+ClopidogRel Following TAVI trial, randomisation to DAPT versus SAPT in 222 patients resulted in an increased risk of major or life-threatening bleeding events but no differences in the rate of myocardial infarction or stroke 14.…”

Section: Antiplatelet Therapymentioning

confidence: 94%

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Nijenhuis

Brouwer

Søndergaard

et al. 2019

Heart

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This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). In the absence of large randomised clinical trials, clinical practice is leaning towards evidence reported in other populations. Due to the greater risk of major bleeding associated with oral anticoagulation using a vitamin-K antagonist (VKA), antiplatelet therapy (APT) may be considered as the first-line treatment of patients undergoing TAVI. Overall, single rather than dual APT is preferred. However, dual APT should be considered in patients with a recent acute coronary syndrome (ie, within 6 months), complex coronary stenting, large aortic arch atheromas or previous non-cardioembolic stroke. Monotherapy with VKA should be considered if concomitant atrial fibrillation or any other indication for long-term oral anticoagulation is present. APT on top of VKA seems only reasonable in patients with recent acute coronary syndrome, extensive or recent coronary stenting or large aortic arch atheromas. A direct-acting oral anticoagulant may be considered if oral anticoagulation is indicated in the absence of contraindications. Initiation of VKA is indicated in clinical valve thrombosis, for example, with high transvalvular gradient, whereas the role of VKA in the case of subclinical leaflet thrombosis is currently uncertain.

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Section: Antiplatelet Therapymentioning

confidence: 94%

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Nijenhuis

Brouwer

Søndergaard

et al. 2019

Heart

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“…A total of 70 full-text articles remained after screening the titles and abstracts. Finally, a total of 7 articles incorporating 1,445 patients were included in the present study after removing review articles, meta-analyses, and irrelevant articles[15, 22-27]. …”

Section: Resultsmentioning

confidence: 99%

“…A total of 794 patients were treated with aspirin plus clopidogrel (or ticlopidine) as the DAPT group, and 651 patients were treated with aspirin or clopidogrel as the SAPT group. Four studies completed a 6-month follow-up[23-16], 2 studies completed 12-month follow-up periods[15, 22], and 1 study was prematurely stopped[27], reporting the 30-day and 3-month outcomes. Five of the included studies used SAPIEN devices[15, 22-23, 25, 27], while the other 2 used CoreValve devices[24, 26].…”

Section: Resultsmentioning

confidence: 99%

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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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“…Given these parameters, it is inevitable that DAPT will be related with increased bleeding risk. On the other hand, no beneficial impact of DAPT over single antiplatelet therapy regarding cerebrovascular event prevention has been proven by several TAVR studies (23)(24)(25)(26). It is well known that 50% of strokes within the first month post TAVR occur periprocedurally or within 24 hours post procedure, whereas the stroke risk seems to peak within the first 7 days post TAVR (11).…”

mentioning

confidence: 99%

Antithrombotic treatment following transcatheter valve replacement: current considerations

2017

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Clinical Outcomes and Bioprosthetic Valve Function After Transcatheter Aortic Valve Implantation Under Dual Antiplatelet Therapy vs. Aspirin Alone

Cited by 46 publications

References 25 publications

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

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

Antithrombotic treatment following transcatheter valve replacement: current considerations

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