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Am J Cardiol. 2014 Jan 15;113(2):355-60. doi: 10.1016/j.amjcard.2013.09.033. Epub 2013 Oct 5.

Comparison of two antiplatelet therapy strategies in patients undergoing transcatheter aortic valve implantation.

Author information

1
University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France; University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France. Electronic address: eric.durand@egp.aphp.fr.
2
University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France; Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
3
Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
4
Université de Bretagne Occidentale, Department of Cardiology, CHU de la Cavale Blanche, EA 4524, Brest, France.
5
University Hospital Dupuytren, Department of cardiac Surgery, Limoges, France.
6
University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
7
University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France.

Abstract

Dual antiplatelet therapy is commonly used in patients undergoing transcatheter aortic valve implantation (TAVI), but the optimal antiplatelet regimen is uncertain and remains to be determined. The objective of this study was to compare 2 strategies of antiplatelet therapy in patients undergoing TAVI. A strategy using monoantiplatelet therapy (group A, n = 164) was prospectively compared with a strategy using dual antiplatelet therapy (group B, n = 128) in 292 consecutive patients undergoing TAVI. The primary end point was a combination of mortality, major stroke, life-threatening bleeding (LTB), myocardial infarction, and major vascular complications at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium. The primary end point occurred in 22 patients (13.4%) in the group A and in 30 patients (23.4%) in the group B (hazard ratio 0.51, 95% confidence interval 0.28 to 0.94, p = 0.026). LTB (3.7% vs 12.5%, p = 0.005) and major bleedings (2.4% vs 13.3%, p <0.0001) occurred less frequently in the group A, whereas the incidence of stroke (1.2% vs 4.7%, p = 0.14) and myocardial infarction (1.2% vs 0.8%, p = 1.0) was not significantly different between the 2 groups. The benefit of a strategy using mono versus dual antiplatelet therapy persisted after multivariate adjustment and propensity score analysis (hazard ratio 0.53, 95% confidence interval 0.28 to 0.95, p = 0.033). In conclusion, a strategy using mono versus dual antiplatelet therapy in patients undergoing TAVI reduces LTB and major bleedings without increasing the risk of stroke and myocardial infarction. The results of our study question the justification of dual antiplatelet therapy and require confirmation in a randomized trial.

PMID:
24169016
DOI:
10.1016/j.amjcard.2013.09.033
[Indexed for MEDLINE]
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