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Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding
  1. Hirofumi Hioki1,
  2. Yusuke Watanabe1,
  3. Ken Kozuma1,
  4. Yugo Nara1,
  5. Hideyuki Kawashima1,
  6. Akihisa Kataoka1,
  7. Masanori Yamamoto2,
  8. Kensuke Takagi3,
  9. Motoharu Araki4,
  10. Norio Tada5,
  11. Shinichi Shirai6,
  12. Futoshi Yamanaka7,
  13. Kentaro Hayashida8
  14. And on behalf of OCEAN-TAVI investigators
  1. 1 Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
  2. 2 Division of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
  3. 3 Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
  4. 4 Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan
  5. 5 Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan
  6. 6 Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
  7. 7 Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
  8. 8 Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
  1. Correspondence to Dr Hirofumi Hioki, Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan; hhioki{at}shinshu-u.ac.jp

Abstract

Objective To evaluate the clinical benefit of pre-procedural antiplatelet therapy in patients undergoing transfemoral (TF) transcatheter aortic valve implantation (TAVI).

Methods OCEAN (Optimized transCathEter vAlvular interveNtion)-TAVI is a prospective, multicentre, observational cohort registry, enrolling 749 patients who underwent TAVI from October 2013 to August 2015 in Japan. We identified 540 patients (median age 85 years, 68.1% female) undergoing TF-TAVI; of these, 80 had no pre-procedural antiplatelet therapy and 460 had antiplatelet therapy. The endpoints were any bleeding (life-threatening, major, and minor bleeding) and thrombotic events (stroke, myocardial infarction, and valve thrombosis) during hospitalisation.

Results Patients with dual antiplatelet therapy (DAPT) had a significantly higher incidence of any bleeding than those with single antiplatelet therapy (SAPT) (36.5% vs 27.5%, p=0.049) and no antiplatelet therapy (36.5% vs 21.3%, p=0.010). Patients without pre-procedural antiplatelet therapy did not experience an increased risk of thrombotic events. In multivariable logistic regression analysis, DAPT before TF-TAVI significantly increased any bleeding compared with SAPT (OR 2.05, 95% CI 1.16 to 3.65) and no antiplatelet therapy (OR 2.30, 95% CI 1.08 to 4.90).

Conclusions The current study demonstrated that DAPT before TF-TAVI increased the risk of bleeding compared with single or no antiplatelet therapy. Lower intensity antiplatelet therapy was not associated with thrombotic events. In modern practice, it might be reasonable to perform TAVI using single or no pre-procedural antiplatelet therapy with an expectation of no increase of adverse events.

Trial registration number UMIN-ID; 000020423; Results.

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