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Short-term dual anti-platelet therapy decreases long-term cardiovascular mortality after transcatheter aortic valve replacement

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Abstract

No data are available on extended dual anti-platelet therapy (DAPT) duration which may influence long-term prognosis (later than 1 year) after transcatheter aortic valve replacement (TAVR). Therefore, this study is aimed to evaluate whether discontinuing DAPT within 1 year had an impact on adverse events after TAVR. Using data from the OCEAN-TAVI registry, we assessed 1008 patients who survived the first year after TAVR with DAPT since discharge. Patients were divided into ‘DAPT group’ (n = 462), comprising patients who took DAPT at both discharge and 1 year, and ‘stop-DAPT group’ (n = 546), comprising patients who took DAPT at discharge and single anti-platelet therapy (SAPT) at 1 year. We compared the incidence of cardiovascular (CV) death, major and minor bleeding, and ischemic stroke later than 1 year after TAVR between the two groups. A total of 28 CV deaths were observed later than 1 year after TAVR. The stop-DAPT group had a significantly lower incidence of CV death than the DAPT group (1.8% vs. 4.9%, log-rank P = 0.029). Stop DAPT was associated with lower CV death later than 1 year of TAVR in Cox regression analysis (adjusted hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.20–0.99), and in analysis with inverse probability of treatment weighting method using propensity score (adjusted HR, 0.45; 95% CI, 0.20–0.98). Our study demonstrated that switching from DAPT to SAPT within 1 year of TAVR was significantly associated with a lower CV death later than 1 year after TAVR.

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References

  1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, PARTNER Trial Investigators (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

    Article  CAS  Google Scholar 

  2. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG, PARTNER 2 Investigators (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620

    Article  CAS  Google Scholar 

  3. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR, PARTNER 3 Investigators (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 380:1695–1705

    Article  Google Scholar 

  4. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group (2017) 2017 ESC/EACTS Guideline for the management of valvular disease. Eur Heart J 38:2739–2791

    Article  Google Scholar 

  5. Chopard R, Teiger E, Meneveau N, Chocron S, Gilard M, Laskar M, Eltchaninoff H, Iung B, Leprince P, Chevreul K, Prat A, Lievre M, Leguerrier A, Donzeau-Gouge P, Fajadet J, Mouillet G, Schiele F, FRANCE-2 Investigators (2015) Baseline characteristics and prognostic implications of pre-existing and new-onset atrial fibrillation after transcatheter aortic valve implantation: results from the FRANCE-2 registry. JACC Cardiovasc Interv 8:1346–1355

    Article  Google Scholar 

  6. Rodés-Cabau J, Masson JB, Welsh RC, Garcia Del Blanco B, Pelletier M, Webb JG, Al-Qoofi F, Généreux P, Maluenda G, Thoenes M, Paradis JM, Chamandi C, Serra V, Dumont E, Côté M (2017) Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with balloon-expandable valve: The ARTE (aspirin versus aspirin + clopidogrel following transcatheter aortic valve implantation) randomized clinical trial. JACC Cardiovasc Interv 10:1357–1365

    Article  Google Scholar 

  7. Mauri L, Kereiakes DJ, Yeh RW, Driscoll-Shempp P, Cutlip DE, Steg PG, Normand SL, Braunwald E, Wiviott SD, Cohen DJ, Holmes DR Jr, Krucoff MW, Hermiller J, Dauerman HL, Simon DI, Kandzari DE, Garratt KN, Lee DP, Pow TK, Ver Lee P, Rinaldi MJ, Massaro JM, DAPT Study Investigators (2014) Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med 371:2155–2166

    Article  Google Scholar 

  8. Yamamoto M, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K, OCEAN-TAVI investigators (2019) Transcatheter aortic valve replacement outcomes in Japan: Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. Cardiovasc Revasc Med 20:843–851

    Article  Google Scholar 

  9. Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J 33:2403–2418

    Article  Google Scholar 

  10. Austin PC (2013) The performance of different propensity score methods for estimating marginal hazard effects. Stat Med 32:2837–2849

    Article  Google Scholar 

  11. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol 70:252–289

    Article  Google Scholar 

  12. Ahmad Y, Demir O, Rajkumar C, Howard JP, Shun-Shin M, Cook C, Petraco R, Jabbour R, Arnold A, Frame A, Sutaria N, Ariff B, Kanaganayagam G, Francis D, Mayet J, Mikhail G, Malik I, Sen S (2018) Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis. Open Heart 5:e000748

    Article  Google Scholar 

  13. Gandhi S, Schwalm JD, Velianou JL, Natarajan MK, Farkouh ME (2015) Comparison of dual-antiplatelet therapy to mono-antiplatelet therapy after transcatheter aortic valve implantation: systemic review and meta-analysis. Can J Cardiol 31:775–784

    Article  Google Scholar 

  14. Costa F, van Klaveren D, James S, Heg D, Räber L, Feres F, Pilgrim T, Hong MK, Kim HS, Colombo A, Steg PG, Zanchin T, Palmerini T, Wallentin L, Bhatt DL, Stone GW, Windecker S, Steyerberg EW, Valgimigli M, PRECISE-DAPT Study Investigators (2017) Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389:1025–1034

    Article  Google Scholar 

  15. Helft G, Steg PG, Le Feuvre C, Georges JL, Carrie D, Dreyfus X, Furber A, Leclercq F, Eltchaninoff H, Falquier JF, Henry P, Cattan S, Sebagh L, Michel PL, Tuambilangana A, Hammoudi N, Boccara F, Cayla G, Douard H, Diallo A, Berman E, Komajda M, Metzger JP, Vicaut E, OPTImal DUAL Antiplatelet Therapy Trial Investigators (2016) Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial. Eur Heart J 37:365–374

    CAS  PubMed  Google Scholar 

  16. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ, Investigators CHARISMA (2006) Clopidogrel and aspirin versus aspirin alone for the prevention of atherosclerotic events. N Engl J Med 354:1706–1717

    Article  CAS  Google Scholar 

  17. Xiong TY, Liao YB, Zhao ZG, Xu YN, Wei X, Zuo ZL, Li YJ, Cao JY, Tang H, Jilaihawi H, Feng Y, Chen M (2015) Causes of death following transcatheter aortic valve replacement: a systemic review and meta-analysis. J Am Heart Assoc 4:e002096

    PubMed  PubMed Central  Google Scholar 

  18. Yeh RW, Kereiakes DJ, Steg PG, Windecker S, Rinaldi MJ, Gershlick AH, Cutlip DE, Cohen DJ, Tanguay JF, Jacobs A, Wiviott SD, Massaro JM, Iancu AC, Mauri L, DAPT Study Investigators (2015) Benefits and risks of extended duration dual antiplatelet therapy after pci in patients with and without acute myocardial infarction. J Am Coll Cardiol 65:2211–2221

    Article  Google Scholar 

  19. Murali-Krishnan R, Iqbal J, Rowe R, Hatem E, Parviz Y, Richardson J, Sultan A, Gunn J (2015) Impact of frailty on outcomes after percutaneous coronary intervention: a prospective cohort study. Open Heart 2:e000294

    Article  Google Scholar 

  20. Hao Q, Tampi M, O'Donnell M, Foroutan F, Siemieniuk RA, Guyatt G (2018) Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischemic attack: systematic review and meta-analysis. BMJ 363:k5108

    Article  Google Scholar 

  21. Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Laschinger J, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock S, Price MJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhoevel U, Yeh RW, Krucoff MW, Morice MC (2019) Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J 40:2632–2653

    Article  CAS  Google Scholar 

  22. Li L, Geraghty OC, Mehta Z, Rothwell PM, Oxford Vascular Study (2017) Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet 390:490–499

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the investigators and institutions that have participated in the OCEAN-TAVI registry. Dr. Yamamoto, Dr. Tada, Dr. Naganuma, Dr. Shirai, Dr. Mizutani, and Dr. Watanabe are clinical proctors for Edwards Lifesciences and Medtronic. Dr. Araki, Dr. Tabata, Dr. Takagi, and Dr. Hayashida are clinical proctors of Edwards Lifesciences. Dr. Ueno is a clinical proctor for Medtronic. The remaining authors have nothing to disclose.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan

    Hirofumi Hioki, Yusuke Watanabe, Ken Kozuma & Akihisa Kataoka

  2. Saiseikai Utsunomiya Hospital, Utsunomiya, Japan

    Fumiaki Yashima

  3. New Tokyo Hospital, Chiba, Japan

    Toru Naganuma

  4. Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan

    Motoharu Araki

  5. Sendai Kosei Hospital, Sendai, Japan

    Norio Tada

  6. Kokura Memorial Hospital, Fukuoka, Japan

    Shinichi Shirai

  7. Shonan Kamakura General Hospital, Kanmakura, Japan

    Futoshi Yamanaka

  8. Osaka City University Graduate School of Medicine, Osaka, Japan

    Kazuki Mizutani

  9. Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan

    Minoru Tabata

  10. Ogaki Municipal Hospital, Ogaki, Japan

    Kensuke Takagi

  11. University of Toyama, Toyama, Japan

    Hiroshi Ueno

  12. Toyohashi Heart Center, Aichi, Japan

    Masanori Yamamoto

  13. Nagoya Heart Center, Aichi, Japan

    Masanori Yamamoto

  14. Keio University School of Medicine, Tokyo, Japan

    Kentaro Hayashida

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  1. Hirofumi Hioki
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  2. Yusuke Watanabe
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  15. Masanori Yamamoto
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OCEAN-TAVI Investigators

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Correspondence to Hirofumi Hioki.

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The OCEAN-TAVI registry is supported by Edwards-Lifesciences, Medtronic, and Daiichi-Sankyo company.

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Hioki, H., Watanabe, Y., Kozuma, K. et al. Short-term dual anti-platelet therapy decreases long-term cardiovascular mortality after transcatheter aortic valve replacement. Heart Vessels 36, 252–259 (2021). https://doi.org/10.1007/s00380-020-01693-y

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