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Valvular heart disease
Original article
Antiplatelet therapy following transcatheter aortic valve implantation
  1. Mariëlla E C J Hassell1,
  2. David Hildick-Smith2,
  3. Eric Durand3,
  4. Wouter J Kikkert1,
  5. Esther M A Wiegerinck1,
  6. Eugenio Stabile4,
  7. Gian Paolo Ussia5,
  8. Sumeet Sharma2,
  9. Jan Baan Jr1,
  10. Hélène Eltchaninoff3,
  11. Paolo Rubino6,
  12. Marco Barbanti7,
  13. Corrado Tamburino7,
  14. Petra Poliacikova2,
  15. Didier Blanchard8,
  16. Jan J Piek1,
  17. Ronak Delewi1
  1. 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Cardiology, Brighton and Sussex University Hospitals, Sussex, UK
  3. 3Department of Cardiology, University hospital of Rouen, Hospital Charles Nicolle, Rouen, France
  4. 4Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Napoli, Italy
  5. 5Cardiologia Interventistica Strutturale Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, Roma, Italy
  6. 6Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy
  7. 7Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
  8. 8Department of Cardiology, University Paris descartes, AP-HP; European Georges Pompidou Hospital, Paris, France
  1. Correspondence to Dr Ronak Delewi, Department of Cardiology, Room B2-213, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; r.delewi{at}amc.nl

Abstract

Objective There is limited evidence to support decision making on antiplatelet therapy following transcatheter aortic valve implantation (TAVI). Our aim was to assess the efficacy and safety of aspirin-only (ASA) versus dual antiplatelet therapy (DAPT) following TAVI.

Methods We performed a systematic review and pooled analysis of individual patient data from 672 participants comparing single versus DAPT following TAVI. Primary endpoint was defined as the composite of net adverse clinical and cerebral events (NACE) at 1 month, including all-cause mortality, acute coronary syndrome (ACS), stroke, life-threatening and major bleeding.

Results At 30 days a NACE rate of 13% was observed in the ASA-only and in 15% of the DAPT group (OR 0.83, 95% CI 0.48 to 1.43, p=0.50). A tendency towards less life-threatening and major bleeding was observed in patients treated with ASA (OR 0.56, 95% CI 0.28 to 1.11, p=0.09). Also, ASA was not associated with an increased all-cause mortality (OR 0.91, 95% CI 0.36 to 2.27, p=0.83), ACS (OR 0.5, 95% CI 0.05 to 5.51, p=0.57) or stroke (OR 1.21; 95% CI 0.36 to 4.03, p=0.75).

Conclusions No difference in 30-day NACE rate was observed between ASA-only or DAPT following TAVI. Moreover, a trend towards less life-threatening and major bleeding was observed in favour of ASA. Consequently the additive value of clopidogrel warrants further investigation.

https://doi.org/10.1136/heartjnl-2014-307053

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