Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation.

MedStar author(s):
Citation: Jacc: Cardiovascular Interventions. 12(16):1580-1589, 2019 08 26.PMID: 31439338Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anticoagulants/ad [Administration & Dosage] | *Aortic Valve Stenosis/su [Surgery] | *Atrial Fibrillation/dt [Drug Therapy] | *Fibrinolytic Agents/ad [Administration & Dosage] | *Platelet Aggregation Inhibitors/ad [Administration & Dosage] | *Stroke/pc [Prevention & Control] | *Thromboembolism/pc [Prevention & Control] | *Transcatheter Aortic Valve Replacement | Aged | Aged, 80 and over | Anticoagulants/ae [Adverse Effects] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Atrial Fibrillation/di [Diagnosis] | Atrial Fibrillation/mo [Mortality] | Female | Fibrinolytic Agents/ae [Adverse Effects] | Humans | Male | Middle Aged | Platelet Aggregation Inhibitors/ae [Adverse Effects] | Registries | Risk Assessment | Risk Factors | Severity of Illness Index | Stroke/di [Diagnosis] | Stroke/mo [Mortality] | Thromboembolism/di [Diagnosis] | Thromboembolism/mo [Mortality] | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment OutcomeYear: 2019Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: BACKGROUND: The impact of antithrombotic regimens on clinical outcomes in patients with AF and severe aortic stenosis treated with TAVR is unknown.CONCLUSIONS: Among patients with prior AF undergoing TAVR, antiplatelet with or without anticoagulant therapy was associated with a reduced risk of stroke at 2 years, implicating multifactorial stroke mechanisms in this population. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: In the randomized PARTNER II (Placement of Aortic Transcatheter Valve II) trial and associated registries, 1,621 patients with prior AF and CHA2DS2-VASc score >=2 comprised the study cohort. Outcomes were analyzed according to antithrombotic therapy.OBJECTIVES: The study sought to determine the patterns of antithrombotic therapy and association with clinical outcomes in patients with atrial fibrillation (AF) and CHA2DS2-VASc (congestive heart failure, hypertension, age >=75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score >=2 following transcatheter aortic valve replacement (TAVR).RESULTS: During the 5-year enrollment period, 933 (57.6%) patients were discharged on oral anticoagulant therapy (OAC). Uninterrupted antiplatelet therapy (APT) for at least 6 months or until an endpoint event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of patients not on OAC. At 2 years, patients on OAC had a similar rate of stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT. Following adjustment, OAC with APT and APT alone were both associated with reduced rates of stroke compared with no OAC or APT (hazard ratio for OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p = 0.002), while OAC alone was not.All authors: Alu MC, Biviano A, Chakravarty T, Kodali S, Kosmidou I, Leon MB, Liu M, Liu Y, Madhavan M, Makkar R, Thourani VHOriginally published: Jacc: Cardiovascular Interventions. 12(16):1580-1589, 2019 Aug 26.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-10-10
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31439338 Available 31439338

Available online through MWHC library: 2008 - present

BACKGROUND: The impact of antithrombotic regimens on clinical outcomes in patients with AF and severe aortic stenosis treated with TAVR is unknown.

CONCLUSIONS: Among patients with prior AF undergoing TAVR, antiplatelet with or without anticoagulant therapy was associated with a reduced risk of stroke at 2 years, implicating multifactorial stroke mechanisms in this population. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: In the randomized PARTNER II (Placement of Aortic Transcatheter Valve II) trial and associated registries, 1,621 patients with prior AF and CHA2DS2-VASc score >=2 comprised the study cohort. Outcomes were analyzed according to antithrombotic therapy.

OBJECTIVES: The study sought to determine the patterns of antithrombotic therapy and association with clinical outcomes in patients with atrial fibrillation (AF) and CHA2DS2-VASc (congestive heart failure, hypertension, age >=75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score >=2 following transcatheter aortic valve replacement (TAVR).

RESULTS: During the 5-year enrollment period, 933 (57.6%) patients were discharged on oral anticoagulant therapy (OAC). Uninterrupted antiplatelet therapy (APT) for at least 6 months or until an endpoint event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of patients not on OAC. At 2 years, patients on OAC had a similar rate of stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT. Following adjustment, OAC with APT and APT alone were both associated with reduced rates of stroke compared with no OAC or APT (hazard ratio for OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p = 0.002), while OAC alone was not.

English

Powered by Koha