Usefulness of Antiplatelet Therapy After Transcatheter Aortic Valve Implantation. [Review]

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Citation: American Journal of Cardiology. 149:57-63, 2021 06 15.PMID: 33753035Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Interventional Cardiology Fellowship | MedStar Heart & Vascular InstitutForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Dual Anti-Platelet Therapy/mt [Methods] | *Hemorrhage/ci [Chemically Induced] | *Mortality | *Platelet Aggregation Inhibitors/tu [Therapeutic Use] | *Stroke/ep [Epidemiology] | *Thrombosis/pc [Prevention & Control] | *Transcatheter Aortic Valve Replacement | Aspirin/tu [Therapeutic Use] | Cause of Death | Clopidogrel/tu [Therapeutic Use] | Endothelium | Evidence-Based Medicine | Hemorrhage/ep [Epidemiology] | Humans | Thrombosis/ep [Epidemiology]Year: 2021ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: The rationale for dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI) is to facilitate endothelialization of metallic struts of the transcatheter heart valve and to prevent thrombosis that could lead to thromboembolic events. Based on expert consensus, current societal guidelines recommend DAPT for 1 to 6 months after TAVI with weak evidence. Although the pivotal TAVI trials mandated this regimen, the evidence for the efficacy of DAPT to prevent transcatheter heart valve thrombosis is limited to 3 small trials and a handful of observational studies. Multiple coronary trials have demonstrated that DAPT is associated with increased bleeding in comparison with single antiplatelet therapy, especially in elderly patients. TAVI patients are predominantly elderly and frequently have risk factors that predispose them to bleeding. Herein, we summarize the evidence for antiplatelet therapy after TAVI and explore the theoretical benefit of DAPT to prevent thromboembolic events versus the risk of increased bleeding. Copyright (c) 2021 Elsevier Inc. All rights reserved.All authors: Ben-Dor I, Case BC, Forrestal BJ, Mintz GS, Rogers T, Satler LF, Waksman R, Yerasi COriginally published: American Journal of Cardiology. 2021 Mar 19Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33753035 Available 33753035

The rationale for dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI) is to facilitate endothelialization of metallic struts of the transcatheter heart valve and to prevent thrombosis that could lead to thromboembolic events. Based on expert consensus, current societal guidelines recommend DAPT for 1 to 6 months after TAVI with weak evidence. Although the pivotal TAVI trials mandated this regimen, the evidence for the efficacy of DAPT to prevent transcatheter heart valve thrombosis is limited to 3 small trials and a handful of observational studies. Multiple coronary trials have demonstrated that DAPT is associated with increased bleeding in comparison with single antiplatelet therapy, especially in elderly patients. TAVI patients are predominantly elderly and frequently have risk factors that predispose them to bleeding. Herein, we summarize the evidence for antiplatelet therapy after TAVI and explore the theoretical benefit of DAPT to prevent thromboembolic events versus the risk of increased bleeding. Copyright (c) 2021 Elsevier Inc. All rights reserved.

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