Can TAVI patients receive aspirin monotherapy as patients after surgical aortic bioprosthesis implantation? Data from the Polish Registry — POL-TAVI. (15th January 2017)

• Record Type: Journal Article
• Authors: Czerwińska-Jelonkiewicz, Katarzyna; Zembala, Marian; Dąbrowski, Maciej; Witkowski, Adam; Ochała, Andrzej; Kochman, Janusz; Dudek, Dariusz; Kübler, Piotr; Jagielak, Dariusz; Stępińska, Janina
• Is Part Of: International journal of cardiology. Volume 227(2017)
• Page Start: 305
• Page End: 311
• Publication Date: 2017-01-15
• Subjects: Transcatheter aortic valve implantation -- Bleeding -- Vascular complications -- Dual antiplatelet therapy; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.11.095
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: 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 results: All 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. Conclusion: Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis.