Impact of Antithrombotic Regimen on Mortality, Ischemic, and Bleeding Outcomes after Transcatheter Aortic Valve Replacement

Abstract

IntroductionOptimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) remains unclear. We evaluated the association between antithrombotic regimens and outcomes in TAVR patients.MethodsWe retrospectively analyzed consecutive patients who underwent TAVR at a single academic center from April 2009 to March 2014. Antithrombotic regimens were classified as single or dual antiplatelet therapy (AP), single antiplatelet plus anticoagulant (SAC), or triple therapy (TT). The primary endpoint was a composite of death, myocardial infarction (MI), stroke, and major bleeding. Adjusted hazard ratios (HRs) were obtained with best subset variable selection methods using bootstrap resampling.ResultsOf 246 patients who underwent TAVR, 241 were eligible for analysis with 133, 88, and 20 patients in the AP, SAC, and TT groups, respectively. During a median 2.1-year follow-up, 53.5% had at least one endpoint—the most common was death (68%), followed by major bleeding (23%), stroke (6%), and MI (3%). At 2 years, the composite outcome occurred in 70% of TT, 42% of SAC, and 31% of AP patients. Compared to AP, adjusted HRs for the composite outcome were 2.88 [95% Confidence intervals (CI) (1.61–5.16); p = 0.0004] and 1.66 (95% CI [1.13-2.42]; p = 0.009) in the TT and SAC groups, respectively. Mortality rates at 2 years were 61% in the TT, 32% in the SAC, and 26% in the AP groups (p = 0.005).ConclusionsThe risk of the composite outcome of death, MI, stroke, or major bleeding at 2-year follow-up was significantly higher in TAVR patients treated with TT or SAC versus AP, even after multivariate adjustment.

Antithrombotic strategies after transcatheter aortic valve implantation: Insights from a network meta‐analysis

“…Our search identified 13 eligible studies, enrolling a total of 20,548 TAVI patients, which included eight studies investigating patients on OAC ( N = 1,386, 6.7%). There were 3 randomized controlled trials, 3 propensity score matched analyses, and 7 retrospective cohort studies (including four studies with adjusted HR).…”

Early 6 months usage of single anTiplAtelet OR anTicoAgulant followed by single antiplatelet after transcatheter aortic valve replacement: protocol for a multicentre, open-label, randomised controlled clinical trial

“…15 16 Although oral anticoagulation (OAC) was also recommended, long-term OAC treatment may increase the risk of bleeding and death in frail elderly nature. 17 Several studies have explored antiplatelet and/or anticoagulant strategies for preventing BPVT after TAVR in patients without anticoagulant indications. [18][19][20] Regrettably, due to the limitation of the studies, the recommendation of antithrombotic strategies were mostly summarised as Class B in many international guidelines.…”