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Antithrombotic therapy in patients undergoing TAVI with concurrent atrial fibrillation. One center experience

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Abstract

Aim of the present study was to record the antithrombotic approach in AF and non-AF patients undergoing TAVI, and to compare the efficiency of the used regimens combination. Antithrombotic approach of patients undergoing TAVI remains a challenging dispute. It becomes even more complex when need for anticoagulant treatment is required due to concurrent atrial fibrillation. Consecutive patients with severe symptomatic aortic stenosis treated with TAVI, were retrospectively studied. All patients were divided into two groups, matched to age, depending on the existence of atrial fibrillation. The primary end-point was the composite of MACE, while the secondary end-point was the occurrence of major bleeding at follow-up. A total of 80 patients were included in the study. Out of them, 20 patients (80.2 ± 5.4 years) suffered from concurrent atrial fibrillation. This group was matched with 20 patients (80.6 ± 3.7 years) with no need for anticoagulation. AF-group patients were treated with clopidogrel plus acenocoumarol for 3 months. Following that, acetylsalicylic acid plus acenocoumarol were prescribed. Non-AF patients were treated with 3 months clopidogrel plus acetylsalicylic acid followed by single acetylsalicylic acid medication. No statistical significant differences in MACE between AF and non-AF group were identified (p = 0.705, phi coefficient = 0.06) (mean follow-up 23.4 ± 14 months). Similarly, there was no statistical significant difference for bleedings among the AF and non-AF patient group (p = 0.658, phi coefficient = 0.14). In patients undergoing TAVI with CoreValve, with concurrent AF, treatment with clopidogrel plus acenocoumarol for 3 months, followed by acetylsalicylic acid plus acenocoumarol, seems safe and effective enough in long-term follow-up.

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References

  1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63(22):2438–2488. doi:10.1016/j.jacc.2014.02.537

    Article  PubMed  Google Scholar 

  2. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–1607. doi:10.1056/NEJMoa1008232

    Article  CAS  PubMed  Google Scholar 

  3. Vahanian A, Alfieri O, Al-Attar N, Antunes M, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr F, Nataf P, Pierard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, Von Segesser LK, Walther T (2008) Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European association of cardio-thoracic surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EuroIntervention 4(2):193–199

    Article  PubMed  Google Scholar 

  4. Vavuranakis M, Voudris V, Vrachatis DA, Thomopoulou S, Toutouzas K, Karavolias G, Tolios I, Sbarouni E, Lazaros G, Chrysohoou C, Khoury M, Brili S, Balanika M, Moldovan C, Stefanadis C (2010) Transcatheter aortic valve implantation, patient selection process and procedure: two centres’ experience of the intervention without general anaesthesia. Hell J Cardiol 51(6):492–500

    Google Scholar 

  5. Kahlert P, Knipp SC, Schlamann M, Thielmann M, Al-Rashid F, Weber M, Johansson U, Wendt D, Jakob HG, Forsting M, Sack S, Erbel R, Eggebrecht H (2010) Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study. Circulation 121(7):870–878. doi:10.1161/CIRCULATIONAHA.109.855866

    Article  PubMed  Google Scholar 

  6. Ghanem A, Muller A, Nahle CP, Kocurek J, Werner N, Hammerstingl C, Schild HH, Schwab JO, Mellert F, Fimmers R, Nickenig G, Thomas D (2010) Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging. J Am Coll Cardiol 55(14):1427–1432. doi:10.1016/j.jacc.2009.12.026

    Article  PubMed  Google Scholar 

  7. Ussia GP, Scarabelli M, Mule M, Barbanti M, Sarkar K, Cammalleri V, Imme S, Aruta P, Pistritto AM, Gulino S, Deste W, Capodanno D, Tamburino C (2011) Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 108(12):1772–1776. doi:10.1016/j.amjcard.2011.07.049

    Article  CAS  PubMed  Google Scholar 

  8. Moretti C, D’Amico M, D’Ascenzo F, Colaci C, Salizzoni S, Tamburino C, Presbitero P, Marra S, Sheiban I, Gaita F (2014) Impact on prognosis of periprocedural bleeding after TAVI: mid-term follow-up of a multicenter prospective study. J Interv Cardiol 27(3):293–299. doi:10.1111/joic.12115

    Article  PubMed  Google Scholar 

  9. Stepinska J, Czerwinska K, Witkowski A, Dabrowski M, Chmielak Z, Kusmierski K, Hryniewiecki T, Demkow M (2013) Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI). Cardiol J 20(2):125–133. doi:10.5603/CJ.2013.0024

    Article  PubMed  Google Scholar 

  10. Poliacikova P, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D (2013) Antiplatelet and antithrombotic treatment after transcatheter aortic valve implantation—comparison of regimes. J Invasive Cardiol 25(10):544–548

    PubMed  Google Scholar 

  11. Collet JP, Montalescot G (2013) Antithrombotic and antiplatelet therapy in TAVI patients: a fallow field? EuroIntervention 9:S43–S47. doi:10.4244/EIJV9SSA9

    Article  PubMed  Google Scholar 

  12. Lynch DR Jr, Dantzler D, Robbins M, Zhao D (2013) Considerations in antithrombotic therapy among patients undergoing transcatheter aortic valve implantation. J Thromb Thrombolysis 35(4):476–482. doi:10.1007/s11239-013-0886-z

    Article  CAS  PubMed  Google Scholar 

  13. Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C, Morel MA, Petersen J, Popma JJ, Takkenberg JJ, Vahanian A, van Es GA, Vranckx P, Webb JG, Windecker S, Serruys PW (2011) Standardized endpoint definitions for Transcatheter Aortic Valve Implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol 57(3):253–269. doi:10.1016/j.jacc.2010.12.005

    Article  PubMed  Google Scholar 

  14. Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ, Herrman JP, Adriaenssens T, Vrolix M, Heestermans AA, Vis MM, Tijsen JG, van ‘t Hof AW, ten Berg JM (2013) 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 381(9872):1107–1115. doi:10.1016/S0140-6736(12)62177-1

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 1st Department of Cardiology, Hippokration Hospital, University of Athens, 13 Astypaleas, Anoixi, 14569, Attiki, Athens, Greece

    Manolis Vavuranakis, Konstantinos Kalogeras, Dimitrios Vrachatis, Maria Kariori, Carmen Moldovan, Evelina Mpei, Maria Lavda, Angelos-Michail Kolokathis, Gerasimos Siasos & Dimitrios Tousoulis

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  1. Manolis Vavuranakis
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  2. Konstantinos Kalogeras
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  3. Dimitrios Vrachatis
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  4. Maria Kariori
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  5. Carmen Moldovan
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  6. Evelina Mpei
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  7. Maria Lavda
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  8. Angelos-Michail Kolokathis
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  9. Gerasimos Siasos
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  10. Dimitrios Tousoulis
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Correspondence to Konstantinos Kalogeras.

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Vavuranakis, M., Kalogeras, K., Vrachatis, D. et al. Antithrombotic therapy in patients undergoing TAVI with concurrent atrial fibrillation. One center experience. J Thromb Thrombolysis 40, 193–197 (2015). https://doi.org/10.1007/s11239-015-1210-x

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