PT  - JOURNAL ARTICLE
AU  - Hioki, Hirofumi
AU  - Watanabe, Yusuke
AU  - Kozuma, Ken
AU  - Nara, Yugo
AU  - Kawashima, Hideyuki
AU  - Kataoka, Akihisa
AU  - Yamamoto, Masanori
AU  - Takagi, Kensuke
AU  - Araki, Motoharu
AU  - Tada, Norio
AU  - Shirai, Shinichi
AU  - Yamanaka, Futoshi
AU  - Hayashida, Kentaro
TI  - Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding
AID  - 10.1136/heartjnl-2016-309735
DP  - 2017 Mar 01
TA  - Heart
PG  - 361--367
VI  - 103
IP  - 5
4099  - http://heart.bmj.com/content/103/5/361.short
4100  - http://heart.bmj.com/content/103/5/361.full
SO  - Heart2017 Mar 01; 103
AB  - 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.