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Thromb Res. 2015 Jul;136(1):112-7. doi: 10.1016/j.thromres.2015.05.004. Epub 2015 May 14.

Pre-procedural dual antiplatelet therapy and bleeding events following transcatheter aortic valve implantation (TAVI).

Author information

1
Ist Department of Cardiology, Medical University of Warsaw, Poland. Electronic address: zhuczek@wp.pl.
2
Ist Department of Cardiology, Medical University of Warsaw, Poland.
3
Ist Department of Cardiology, Medical University of Poznan, Poland.
4
IIIrd Department of Cardiology, Silesian Medical University, Poland.
5
Department of Cardiosurgery, Medical University of Warsaw, Poland.
6
Medical Department, Ludwig Maximilians University, Munich, Germany.

Abstract

INTRODUCTION:

Transcatheter aortic valve implantation (TAVI) is associated with bleeding that increases mortality. Dual antiplatelet therapy (DAPT) is recommended in TAVI, however little is known about pre-procedural DAPT use and its impact on hemostasis. We sought to determine the frequency, predictors and bleeding events in patients receiving DAPT before TAVI.

METHODS:

Three-hundred-and-three (n=303, 78.6±7.6years, 49% female, EuroScore 23.1±16.9) consecutive patients undergoing TAVI were prospectively analyzed and followed for in-hospital events. According to pre-procedural antiplatelet status study population was divided into 2 groups: patients receiving aspirin and clopidogrel (DAPT) and those on aspirin only or no antiplatelet therapy (noDAPT).

RESULTS:

Pre-procedural DAPT was used in 139 cases (46%). Previous PCI (OR 4.8, [2.8-8.3], p<0.0001), implantation of self-expandable prosthesis (OR 2.2, [1.2-4], p=0.007) femoral access (OR 2.2, [1.1-4.5], p=0.029) and platelet count (OR 1.006, [1.002-1.01], p=0.002) were identified as independent predictors of pre-procedural DAPT. No difference was observed in the rates of any bleeding (23% in DAPT vs. 24.4% in noDAPT, p=0.930) or major/life-threatening bleeding (12.2% in DAPT vs. 14.7% in noDAPT, p=0.715). Propensity-score matching analysis did not alter the results. GFR <30ml/min was the strongest predictor of bleeding (OR 4.3, [1.9-9.9], p=0.0005). There was a trend towards lower frequency of MI and stroke/TIA in DAPT as compared with noDAPT (3.6% vs. 9.8%, p=0.082).

CONCLUSIONS:

Pre-procedural DAPT is frequent and does not increase short-term bleeding complications or need for transfusion following TAVI. Possible impact of DAPT use before TAVI on ischemic complications needs to be investigated in larger populations.

PMID:
26004748
DOI:
10.1016/j.thromres.2015.05.004
[Indexed for MEDLINE]

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