No Antithrombotic Therapy After Transcatheter Aortic Valve Replacement

医学 抗血栓 阿司匹林 氯吡格雷 内科学 阀门更换 入射(几何) 心脏病学 心肌梗塞 冲程(发动机) 养生 外科 狭窄 工程类 物理 光学 机械工程
作者
Yusuke Kobari,Taku Inohara,Hikaru Tsuruta,Fumiaki Yashima,Hideyuki Shimizu,Keiichi Fukuda,Toru Naganuma,Kazuki Mizutani,Masahiro Yamawaki,Norio Tada,Futoshi Yamanaka,Shinichi Shirai,Minoru Tabata,Hiroshi Ueno,Kensuke Takagi,Yusuke Watanabe,Masanori Yamamoto,Kentaro Hayashida
出处
期刊:Jacc-cardiovascular Interventions [Elsevier BV]
卷期号:16 (1): 79-91 被引量:20
标识
DOI:10.1016/j.jcin.2022.10.010
摘要

Several trials demonstrated that aspirin monotherapy compared with aspirin plus clopidogrel is associated with a lower incidence of bleeding without an increased risk of ischemic events in patients after transcatheter aortic valve replacement (TAVR); however, there remains a paucity of data to prove the necessity of even aspirin monotherapy.This study aimed to compare clinical outcomes and valve performance of the 3 different antithrombotic strategies post-TAVR from the OCEAN-TAVI (Optimized transCathEter vAlvular iNtervention) registry.Patients who received anticoagulation or had procedural complications were excluded. The remaining patients were classified into 3 groups according to the antithrombotic regimen at discharge: 1) nonantithrombotic therapy (None); 2) single-antiplatelet therapy (SAPT); and 3) dual-antiplatelet therapy (DAPT). The primary outcome was the incidence of net adverse clinical events (NACEs) (ie, cardiovascular death, stroke, myocardial infarction, and life-threatening or major bleeding).Overall, 3,575 TAVR patients were included (None, 293; SAPT, 1,354; DAPT, 1,928). The median follow-up period was 841 days (IQR: 597-1,340 days). The incidence of NACEs did not differ between the groups (None vs SAPT: adjusted HR [aHR]: 1.18; P = 0.45; None vs DAPT: aHR: 1.09; P = 0.67). There was a lower incidence of all bleeding in patients with no antithrombotics (None vs SAPT: aHR: 0.63; P = 0.12; None vs DAPT: aHR: 0.51; P = 0.04). The valve performance was similar among the groups. Leaflet thrombosis was detected in 8.5% of the nonantithrombotic group.Compared with SAPT/DAPT, the nonantithrombotic strategy was not associated with an increased risk of NACEs and potentially reduced the risk of bleeding events. The nonantithrombotic strategy may be an acceptable alternative to SAPT/DAPT in selected patients with TAVR.
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