RT Journal Article
T1 Warfarin and Antiplatelet Therapy Versus Warfarin Alone for Treating Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement
A1 Altisent, Omar Abdul-Jawad
A1 Durand, Eric
A1 Munoz-Garcia, Antonio J.
A1 Nombela-Franco, Luis
A1 Cheema, Asim
A1 Kefer, Joelle
A1 Gutierrez, Enrique
A1 Benitez, Luis M.
A1 Amat-Santos, Ignacio J.
A1 Serra, Vicenc
A1 Eltchaninoff, Helene
A1 Alnasser, Sami M.
A1 Elizaga, Jaime
A1 Dager, Antonio
A1 del Blanco, Bruno Garcia
A1 del Rosario Ortas-Nadal, Maria
A1 Ramon Marsal, Josep
A1 Campelo-Parada, Francisco
A1 Regueiro, Ander
A1 del Trigo, Maria
A1 Dumont, Eric
A1 Puri, Rishi
A1 Rodes-Cabau, Josep
K1 bleeding
K1 stroke
K1 transcatheter aortic valve replacement
K1 warfarin
K1 Oral anticoagulant-therapy
K1 Aspirin
K1 Implantation
K1 Disease
K1 Risk
K1 Definitions
K1 Clopidogrel
K1 Management
K1 Society
AB OBJECTIVES The study sought to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant atrial fibrillation (AF).BACKGROUND Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce.METHODS A multicenter evaluation comprising 621 patients with AF undergoing TAVR was undertaken. Post-TAVR prescriptions were used to determine the antithrombotic regimen used according to the following 2 groups: monotherapy (MT) with VKA (n = 101) or multiple antithrombotic therapy (MAT) with VKA plus 1 or 2 antiplatelet agents (aspirin or clopidogrel; n = 520). Endpoint definitions were in accordance with Valve Academic Research Consortium-2 criteria. The rate of stroke, major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death), major or life-threatening bleeding events, and death were assessed by a Cox multivariate model regression survival analysis according to the antithrombotic regime used.RESULTS During a median follow-up of 13 months (interquartile range: 3 to 31 months) there were no differences between groups in the rate of stroke (MT: 5%, MAT: 5.2%; adjusted hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 0.45 to 3.48; p = 0.67), major adverse cardiovascular events (MT: 13.9%, MAT: 16.3%; adjusted HR: 1.33; 95% CI: 0.75 to 2.36; p = 0.33), and death (MT 22.8%, MAT: 19.2%; adjusted HR: 0.93; 95% CI: 0.58 to 1.50; p = 0.76). A higher risk of major or life-threatening bleeding was found in the MAT group (MT: 14.9%, MAT: 24.4%; adjusted HR: 1.85; 95% CI: 1.05 to 3.28; p = 0.04). These results remained similar when patients receiving VKA plus only 1 antiplatelet agent (n = 463) were evaluated.CONCLUSIONS In TAVR recipients prescribed VKA therapy for AF, concomitant antiplatelet therapy use appears not to reduce the incidence of stroke, major adverse cardiovascular events, or death, while increasing the risk of major or life-threatening bleeding. (C) 2016 by the American College of Cardiology Foundation.
PB Elsevier science inc
SN 1936-8798
YR 2016
FD 2016-08-22
LK http://hdl.handle.net/10668/18812
UL http://hdl.handle.net/10668/18812
LA en
DS RISalud
RD Apr 11, 2025