Dual antiplatelet therapy after TAVR: A drop in the bucket?. (1st April 2019)

• Record Type: Journal Article
• Authors: Ferlini, Marco; Mauri, Silvia; Rossini, Roberta
• Is Part Of: International journal of cardiology. Volume 280(2019)
• Page Start: 46
• Page End: 48
• Publication Date: 2019-04-01
• Subjects: Antiplatelet therapy -- Oral anticoagulant therapy -- TAVR; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.01.069
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Current guidelines recommend a three- to six-months dual antiplatelet therapy (DAPT) in patients undergoing transcatheter aortic valve replacement (TAVR) or to continue with oral anticoagulant agents (OAC) if already indicated before procedure. However, recent studies showed that treatment with aspirin has the same efficacy of DAPT but it was associated with a significant reduction of major bleeding. Furthermore, half of cerebrovascular events, occurring >24 h after procedure, may be related to new onset of atrial fibrillation or to subclinical leaflets thrombosis and they may be prevented by use of OAC rather than antiplatelet therapy. In absence of very high bleeding risk and of recent percutaneous coronary intervention, the use of OAC over SAPT or DAPT might theoretically be considered in patients undergoing TAVR waiting for results of ongoing clinical trials. Highlights: Dual antiplatelet therapy (DAPT) is recommended after transcatheter aortic valve replacement (TAVR). Single antiplatelet therapy (SAPT) seems to provide the same protection by thrombotic events with less bleeding risk. Oral anticoagulant therapy (OAC) was more protective than APT on later cerebrovascular events occurring after TAVR. OAC might theoretically be considered in patients undergoing TAVR without high bleeding risk over SAPT or DAPT.