Antithrombotic therapy in patients undergoing TAVI: an overview of Dutch hospitals
To assess current antithrombotic treatment strategies in the Netherlands in patients undergoing transcatheter aortic valve implantation (TAVI).
For every Dutch hospital performing TAVI (n = 14) an interventional cardiologist experienced in performing TAVI was interviewed concerning heparin, aspirin, thienopyridine and oral anticoagulation treatment in patients undergoing TAVI.
The response rate was 100 %. In every centre, a protocol for antithrombotic treatment after TAVI was available. Aspirin was prescribed in all centres, concomitant clopidogrel was prescribed 13 of the 14 centres. Duration of concomitant clopidogrel was 3 months in over two-thirds of cases. In 2 centres, duration of concomitant clopidogrel was based upon type of prosthesis: 6 months versus 3 months for supra-annular and intra-annular prostheses, respectively.
Leaning on a small basis of evidence and recommendations, the antithrombotic policy for patients undergoing TAVI is highly variable in the Netherlands. As a standardised regimen might further reduce haemorrhagic complications, large randomised clinical trials may help to establish the most appropriate approach.
- Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. CrossRef
- Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. CrossRef
- Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol. 2012;59(25):2317–26. CrossRef
- Khatri PJ, Webb JG, Rodes-Cabau J, et al. Adverse effects associated with transcatheter aortic valve implantation a meta-analysis of contemporary studies. Ann Intern Med. 2013;158(1):35–46. CrossRef
- Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96. CrossRef
- Holmes DR, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol. 2012;59(13):1200–54. CrossRef
- Webb J, Rodés-Cabau J, Fremes S, et al. Transcatheter aortic valve implantation: a Canadian Cardiovascular Society position statement. Can J Cardiol. 2012;28(5):520–8. CrossRef
- THV-Group. Dutch Guidelines for Transcatheter Heart Valve Intervention [Internet]. 2012. Available from: https://www.nvvc.nl/media/richtlijn/167/Guidelines%20THI%202012-DEF.pdf.
- Borz B, Durand E, Godin M, et al. Incidence, predictors and impact of bleeding after transcatheter aortic valve implantation using the balloon-expandable Edwards prosthesis. Heart. 2012;303095:1–6.
- Halliday BP, Dworakowski R, Brickham B, et al. Usefulness of periprocedural bleeding to predict outcome after transcatheter aortic valve implantation. Am J Cardiol. 2012;109(5):724–8. CrossRef
- Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686–95. CrossRef
- Van Mieghem NM, Nuis R-J, Tzikas A, et al. Prevalence and prognostic implications of baseline anaemia in patients undergoing transcatheter aortic valve implantation. EuroIntervention. 2011;7(2):184–91. CrossRef
- Ussia GP, Barbanti M, Petronio AS, et al. Transcatheter aortic valve implantation: 3-year outcomes of self-expanding CoreValve prosthesis. Eur Heart J. 2012;33(8):969–76. CrossRef
- Gilard M, Eltchaninoff H, Iung B, et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012;366(18):1705–15. CrossRef
- Moat NE, Ludman P, De Belder M, et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol. 2011;58(20):2130–8. CrossRef
- Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J. 2011;32(2):198–204. CrossRef
- Nombela-Franco L, Webb JG, De Jaegere PP, et al. Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation. Circulation. 2012;126(25):3041–53. CrossRef
- Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366(18):1696–704. CrossRef
- Nuis R-J, Van Mieghem NM, Schultz CJ, et al. Frequency and causes of stroke during or after transcatheter aortic valve implantation. Am J Cardiol. 2012;109(11):1637–43. CrossRef
- Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation. 2006;114(15):1616–24. CrossRef
- Noble S, Asgar A, Cartier R, et al. Anatomo-pathological analysis after CoreValve Revalving system implantation. EuroIntervention. 2009;5(1):78–85. CrossRef
- Dans AL, Connolly SJ, Wallentin L, et al. Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial. Circulation. 2013;127(5):634–40. CrossRef
- Hansen ML, Sørensen R, Clausen MT, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170(16):1433–41. CrossRef
- Karjalainen PP, Porela P, Ylitalo A, et al. Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting. Eur Heart J. 2007;28(6):726–32. CrossRef
- Lamberts M, Gislason GH, Olesen JB, et al. Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention. J Am Coll Cardiol. 2013 Jun 6.
- Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Feb;12:1107–15.
- Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60(15):1438–54. Elsevier Inc. CrossRef
- Antithrombotic therapy in patients undergoing TAVI: an overview of Dutch hospitals
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Netherlands Heart Journal
Volume 22, Issue 2 , pp 64-69
- Cover Date
- Print ISSN
- Online ISSN
- Bohn Stafleu van Loghum
- Additional Links
- Transcatheter Aortic Valve Implantation (TAVI)
- Dual Antiplatelet Therapy (DAPT)
- Author Affiliations
- 1. Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435, Nieuwegein, the Netherlands
- 2. Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
- 3. Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
- 4. Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
- 5. Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- 6. Department of Cardiology, Amphia Hospital, Breda, the Netherlands
- 7. Department of Cardiology, Medical Centre, Leeuwarden, the Netherlands
- 8. Department of Cardiology, University Medical Centre St. Radboud, Nijmegen, the Netherlands
- 9. Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- 10. Department of Cardiology, University Medical Centre, Groningen, the Netherlands
- 11. Department of Cardiology, University Medical Centre, Leiden, the Netherlands
- 12. Department of Cardiology, Medical University Centre, Maastricht, the Netherlands
- 13. Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
- 14. Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands