Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the BRAVO-3 Randomized Trial)

Nijenhuis, Vincent J.; Berg, Jürrien M. ten; Hengstenberg, Christian; Lefèvre, Thierry; Windecker, Stephan; Hildick‐Smith, David; Kupatt, Christian; Belle, Éric Van; Tron, Christophe; Hink, Hans Ulrich; Colombo, Antonio; Claessen, Bimmer E.; Sartori, Samantha; Chandrasekhar, Jaya; Mehran, Roxana; Anthopoulos, Prodromos; Deliargyris, Efthymios N.; Dangas, George

doi:10.1016/j.amjcard.2019.01.049

Cited by 21 publications

(22 citation statements)

References 42 publications

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“…31 In a recent study, no difference in the rates of ischemic complications was observed between patients who received a loading dose of clopidogrel, compared with those who did not. 32 Although we did not compare patients under DAPT vs. SAPT, our results are consistent with these findings. They suggest that during uneventful TAVI on monotherapy with aspirin, acute per procedure platelet activation remains limited.…”

Section: Discussionsupporting

confidence: 83%

“…In contrast, they were not correlated with serotonin levels at any time (p ¼ 0.89 and 0.93, respectively). Membrane exposure of CD62-P (MFI : 33 and 38 before and after, respectively, p ¼ 0.67), or CD63 (27 [23][24][25][26][27][28][29][30][31][32] and 30 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] , p ¼ 0.36) did not vary and remained low.…”

Section: Local Platelet Activation In Aortic Blood During Tavi Proceduresmentioning

confidence: 99%

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Platelet Activation Is Limited during Transcatheter Aortic Valve Implantation in Patients on Aspirin Monotherapy and without per Procedural Clinical Complications

Dumonteil

Levade

Garcia

et al. 2019

TH Open

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Transcatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valve stenosis (AS). During and early after the procedure, both ischemic events (predominantly stroke) and bleedings remain prevalent. The optimal antithrombotic regimen is still debated. Single- versus dual-antiplatelet therapy is associated with a lower rate of severe bleeding, without difference in thrombotic complications. Although platelets have been empirically targeted, little is known on their contribution to these events primarily related to embolization of thrombotic material and tissue-derived debris from the wounded aortic valve and large vessels. The objective of this study was to assess local platelet activation in blood sampled in the ascending aorta immediately before and within minutes postimplantation. A series of 18 patients with AS on monotherapy with aspirin successfully underwent TAVI with the self-expandable Medtronic CoreValve by transfemoral route. No clinical thrombotic complication occurred at 30-day follow-up. Compared with patients with stable coronary artery disease unscathed of AS and similarly treated by low-dose aspirin, AS patients displayed a chronic state of platelet activation before TAVI, assessed in venous blood using various biomarkers. However, per procedure, in aortic blood, no change occurred between the two time points in the plasma levels of serotonin or 12-lipoxgenase products, or membrane exposure of granule markers CD62-P and CD63. Our results suggest that local acute platelet activation is limited during TAVI on monotherapy with aspirin.

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Section: Discussionsupporting

confidence: 83%

Section: Local Platelet Activation In Aortic Blood During Tavi Proceduresmentioning

confidence: 99%

Platelet Activation Is Limited during Transcatheter Aortic Valve Implantation in Patients on Aspirin Monotherapy and without per Procedural Clinical Complications

Dumonteil

Levade

Garcia

et al. 2019

TH Open

View full text Add to dashboard Cite

show abstract

“…We were unable to perform detailed analyses of timing of events, for example to glean if the majority of events occurred early after the procedure and were related to access-site complications or were predominantly related to the clopidogrel loading dose; this data was not reported in the individual trials. There is trial data to suggest that the use of a loading dose of clopidogrel is associated with greater vascular complications [ 26 ]. This analysis does not apply to patients who have other indications for anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Single Versus Dual Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Clinical Trials

Ahmad

Howard

Madhavan

et al. 2022

Cardiovascular Revascularization Medicine

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Background Guidelines recommend dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) but guidelines predate the publication of the largest randomized trial. There have been few trials in the field to date, and with a small number of total patients; pooling their results may therefore be helpful. Methods We systematically identified all randomized trials comparing SAPT to DAPT after TAVR. The primary endpoint was the risk of major bleeding. Secondary endpoints included all bleeding, life-threatening bleeding, stroke, myocardial infarction, death and cardiac death. Results Four trials, randomizing 1086 participants, were eligible (541 randomized to SAPT and 545 randomized to DAPT). The weighted mean follow-up was 9.1 months. The risk of major bleeding was significantly increased after DAPT (relative risk (RR) 2.36, 95% confidence interval (CI) 1.27 to 4.40, P = 0.007). There was a similar increased risk for all bleeding (RR 1.65, 95% CI 1.24 to 2.19, P < 0.001), although not for life-threatening bleeding (RR 1.44, 95% CI 0.74 to 2.77, P = 0.282). There were no significant differences in the risk of stroke, myocardial infarction (MI), death or cardiac death. There was no heterogeneity observed for any endpoint (I 2 = 0.0%). Conclusions DAPT after TAVR is associated with an increased risk of major bleeding and all bleeding. There is no evidence of a significant difference between DAPT or SAPT for the risks of stroke, MI, death or cardiac death. However, the total number of patients randomized is small and the duration of follow-up is short. Larger scale randomized trials with longer follow-up are required to assess for any potential differences in ischemic endpoints or mortality.

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“…In patients already on antiplatelet therapy this is often continued during TAVI as single antiplatelet therapy (SAPT), except for patients with recent coronary stenting in whom dual antiplatelet therapy (DAPT) is indicated [36,37]. Several studies have shown that adding clopidogrel before TAVI, either using a loading dose or as maintenance therapy, is not associated with any patient benefit [10,38,39]. However, the optimal timing of administration (before or after TAVI) and type of SAPT (Aspirin or a P 2 Y 12 inhibitor) still lacks of supporting evidence.…”

Section: Periprocedural Antithrombotic Therapymentioning

confidence: 99%

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

Ginkel

Bor

Veenstra

et al. 2022

European Journal of Internal Medicine

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Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the BRAVO-3 Randomized Trial)

Cited by 21 publications

References 42 publications

Platelet Activation Is Limited during Transcatheter Aortic Valve Implantation in Patients on Aspirin Monotherapy and without per Procedural Clinical Complications

Platelet Activation Is Limited during Transcatheter Aortic Valve Implantation in Patients on Aspirin Monotherapy and without per Procedural Clinical Complications

Single Versus Dual Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Clinical Trials

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

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