Evolving concepts in the management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Ginkel, Dirk Jan van; Bor, W L; Veenstra, Leo; Hof, Arnoud W J van 't; Fabris, Enrico

doi:10.1016/j.ejim.2022.05.002

Cited by 10 publications

(6 citation statements)

References 84 publications

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“…Monotherapy with aspirin decreased all types of bleeding events and cardiovascular and all-cause mortality. However, valvular thrombosis was similar between both groups ( 11 , 12 ). Oral anticoagulation (OAC) treatment prevents the formation of thrombus, but its usage is only limited to those with an indication such as atrial fibrillation and clinically significant valve thrombosis.…”

Section: Discussionmentioning

confidence: 79%

“…As for patients with an indication for anticoagulation, monotherapy with OAC is indicated unless a recent percutaneous intervention was done. In this case, studies showed that the addition of P2Y12 inhibitor to OAC for up to 6 months was clinically effective ( 12 ). There are still no clear recommendations regarding the usage of OAC with subclinical valve thrombosis.…”

Section: Discussionmentioning

confidence: 97%

“…Oral anticoagulation (OAC) treatment prevents the formation of thrombus, but its usage is only limited to those with an indication such as atrial fibrillation and clinically significant valve thrombosis. The higher risk of bleeding with anticoagulation is a major concern ( 12 ). GALILEO and ATLANTIS studies in which rivaroxaban and apixaban were used, respectively, showed no clinical benefit to OAC.…”

Section: Discussionmentioning

confidence: 99%

“…GALILEO and ATLANTIS studies in which rivaroxaban and apixaban were used, respectively, showed no clinical benefit to OAC. An increased risk of bleeding and even thromboembolism was noted with GALILEO ( 3 , 12 ). As for patients with an indication for anticoagulation, monotherapy with OAC is indicated unless a recent percutaneous intervention was done.…”

Section: Discussionmentioning

confidence: 99%

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Case report: acute myocardial infarction in the setting of acute transcatheter aortic valve thrombus

Hebbo

Khoury

Iskandarani

et al. 2023

Front. Cardiovasc. Med.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Case report: acute myocardial infarction in the setting of acute transcatheter aortic valve thrombus

Hebbo

Khoury

Iskandarani

et al. 2023

Front. Cardiovasc. Med.

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“…Another special situation that may complicate the management of antithrombotic therapy with TAVI regards patients with concomitant coronary stent implantation. Considering the lack of clear scientific evidence, an extrapolation of the common practice of patients undergoing PCI is currently indicated, with personalized treatment choices based on individual risk possibly preferred in this higher-risk population [80]. The 2021 Expert Consensus Document of the Thrombosis Working Group of the ESC and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) [81] provided recommendations on antithrombotic treatment in this setting.…”

Section: Special Conditions: Patients Undergoing Concomitant Coronary...mentioning

confidence: 99%

Antithrombotic Therapy in Patients Undergoing Transcatheter Aortic Valve Implantation

Pallante,

Costa,

Garcia Ruiz

et al. 2024

JCM

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Transcatheter aortic valve implantation (TAVI) now represents the mainstay of treatment for severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as the cornerstone. Leveraging data from multiple randomized controlled trials, the current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without or with atrial fibrillation, respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.

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The impact of stroke and bleeding on mortality and quality of life during the first year after TAVI: A POPular TAVI subanalysis

van Nuland,

van Ginkel,

Overduin

et al. 2024

Cathet Cardio Intervent

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BackgroundBleeding and stroke are frequent complications after transcatheter aortic valve implantation (TAVI). The mortality risk associated with these events has been reported before, but data regarding their impact on health‐related quality of life (QoL) is limited.AimTo evaluate the impact of bleeding and stroke occurring within 30 days after TAVI, on mortality and QoL during the first year after TAVI.MethodsPOPular TAVI was a randomized clinical trial that evaluated the addition of clopidogrel to aspirin or oral anticoagulation in patients undergoing TAVI. Besides clinical outcomes, QoL was assessed using the Short Form‐12 and EuroQoL Five Dimensions questionnaires before, and at 3, 6, and 12 months after TAVI.ResultsMajor or life‐threatening bleeding occurred in 81 patients (8.3%) and was associated with an increased risk of death (hazard ratio [HR] 1.95 [95% confidence interval (CI) 1.00–3.79]); minor bleeding occurred in 104 patients (10.6%) and was not associated with mortality (HR 0.75 [95% CI 0.30–1.89]). Stroke occurred in 35 patients (3.6%) and was associated with an increased risk of death (HR 2.90 [95% CI 1.23–6.83]). Mean mental component summary (MCS‐12) scores over time were lower in patients with major or life‐threatening bleeding (p = 0.01), and similar in patients with minor bleeding, compared to patients without bleeding; mean physical component summary (PCS‐12) scores, EQ‐5D index, and visual analog scale (VAS) were similar between those patients. Mean MCS‐12 scores were lower in patients with stroke (p = 0.01), mean PCS‐12, EQ‐5D index, and VAS were similar compared to patients without stroke.ConclusionMajor or life‐threatening bleeding and stroke were associated with an increased risk of death and decreased mental QoL in the first year after TAVI.

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Evolving concepts in the management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Cited by 10 publications

References 84 publications

Case report: acute myocardial infarction in the setting of acute transcatheter aortic valve thrombus

Case report: acute myocardial infarction in the setting of acute transcatheter aortic valve thrombus

Antithrombotic Therapy in Patients Undergoing Transcatheter Aortic Valve Implantation

The impact of stroke and bleeding on mortality and quality of life during the first year after TAVI: A POPular TAVI subanalysis

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