Clinical Outcomes and Bioprosthetic Valve Function After Transcatheter Aortic Valve Implantation Under Dual Antiplatelet Therapy vs. Aspirin Alone.

Abstract

BACKGROUND:

Dual antiplatelet therapy (DAPT) is commonly used after transcatheter aortic valve implantation (TAVI); however, the supporting evidence is limited. To determine if aspirin alone is a better alternative to DAPT, we compared the outcomes of patients treated with DAPT or aspirin alone after TAVI.Methods and Results:We analyzed a total of 144 consecutive patients (92 females, mean age 83±6 years) who underwent implantation of a balloon-expandable transcatheter valve (SAPIEN or SAPIEN XT, Edwards Lifesciences). Patients were divided into DAPT (n=66) or aspirin-alone treatment groups (n=78). At 1 year after TAVI, the composite endpoint, which consisted of all-cause death, myocardial infarction, stroke, and major or life-threatening bleeding complications, occurred significantly less frequently (Kaplan-Meier analysis) in the aspirin-alone group (15.4%) than in the DAPT group (30.3%; P=0.031). Valve function assessed by echocardiography was similar between the 2 treatment groups with respect to effective orifice area (1.78±0.43 cm2in DAPT vs. 1.91±0.46 cm2in aspirin-alone group; P=0.13) and transvalvular pressure gradient (11.1±3.5 mmHg in DAPT vs. 10.3±4.1 mmHg in aspirin-alone group; P=0.31).

CONCLUSIONS:

Treatment with aspirin alone after TAVI had greater safety benefits and was associated with similar valve function as DAPT. These results suggest that treatment with aspirin alone is an acceptable regimen for TAVI patients.

• Authors: Yasuhiro Ichibori, Isamu Mizote, Koichi Maeda, Toshinari Onishi, Tomohito Ohtani, Osamu Yamaguchi, Kei Torikai, Toru Kuratani, Yoshiki Sawa, Satoshi Nakatani, Yasushi Sakata
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 81 Issue 3 Pg. 397-404 (Feb 24 2017) ISSN: 1347-4820 [Electronic] Japan
• PMID: 28123149 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (surgery)
• Aortic Valve Stenosis (mortality, therapy)
• Aspirin (administration & dosage)
• Bioprosthesis
• Disease-Free Survival
• Female
• Follow-Up Studies
• Heart Valve Prosthesis
• Humans
• Male
• Platelet Aggregation Inhibitors (administration & dosage)
• Survival Rate
• Transcatheter Aortic Valve Replacement