Can TAVI patients receive aspirin monotherapy as patients after surgical aortic bioprosthesis implantation? Data from the Polish Registry — POL-TAVI

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• 作者：Katarzyna Czerwińska-Jelonkiewicz^a ; ¹ ; ^{kasia_czerwinska@vp.pl} ; Marian Zembala^b ; ¹ ; Maciej Dąbrowski^c ; ¹ ; Adam Witkowski^c ; ¹ ; Andrzej Ochała^d ; ¹ ; Janusz Kochman^e ; ¹ ; Dariusz Dudek^f ; ¹ ; Piotr Kü ; bler^g ; ¹ ; Dariusz Jagielak^h ; ¹ ; Janina Stępińska^a ; ¹
• 关键词：Transcatheter aortic valve implantation ; Bleeding ; Vascular complications ; Dual antiplatelet therapy
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：305-311
• 全文大小：434 K
• 卷排序：227

文摘

This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI).Methods and resultsAll patients who underwent TAVI in the participating centers between 2013 and 2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35–93 years old (79.31 ± 7.53); 457 (55.29%) women. Endpoints noted: severe bleeding – 130 (15.72%) pts, vascular complications – 135 (16.32%) pts, thromboembolic events – 29 (3.5%) pts, myocardial infarction – 24 (2.90%) pts, deaths – 58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95%CI [0.345–0.938]; p = 0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95%CI [0.0217–0.372]; p = 0.001) and bleeding (OR 0.138 95%CI [0.043–0.447]; p = 0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95%CI [0.009–0.529]; p = 0.01 for vascular complications, OR 0.176 95%CI [0.049–0.627]; p = 0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively.ConclusionAspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis.