MedStar Authors catalog › Details for: Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation.
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Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation.

by Thourani, Vinod H.
Citation: ; Jacc: Cardiovascular Interventions. 12(16):1580-1589, 2019 08 26..Journal: JACC. Cardiovascular interventions.Published: ; 2019; ISSN: 1936-8798.Full author list: Alu MC; Biviano A; Chakravarty T; Kodali S; Kosmidou I; Leon MB; Liu M; Liu Y; Madhavan M; Makkar R; Thourani VH.UI/PMID: 31439338.Subject(s): Aged | Treatment Outcome | *Transcatheter Aortic Valve Replacement | Transcatheter Aortic Valve Replacement/mo [Mortality] | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Time Factors | *Thromboembolism/pc [Prevention & Control] | Thromboembolism/mo [Mortality] | Thromboembolism/di [Diagnosis] | *Stroke/pc [Prevention & Control] | Stroke/mo [Mortality] | Stroke/di [Diagnosis] | Severity of Illness Index | Risk Factors | Risk Assessment | Registries | Platelet Aggregation Inhibitors/ae [Adverse Effects] | *Platelet Aggregation Inhibitors/ad [Administration & Dosage] | Middle Aged | Male | Humans | Fibrinolytic Agents/ae [Adverse Effects] | *Fibrinolytic Agents/ad [Administration & Dosage] | Female | Atrial Fibrillation/mo [Mortality] | *Atrial Fibrillation/dt [Drug Therapy] | Atrial Fibrillation/di [Diagnosis] | *Aortic Valve Stenosis/su [Surgery] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Anticoagulants/ae [Adverse Effects] | *Anticoagulants/ad [Administration & Dosage] | Aged, 80 and overInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: ; JACC Cardiovasc Interv. 12(16):1580-1589, 2019 08 26.Local Holdings: Available online through MWHC library: 2008 - present.Abstract: BACKGROUND: The impact of antithrombotic regimens on clinical outcomes in patients with AF and severe aortic stenosis treated with TAVR is unknown.Abstract: 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.Abstract: 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.Abstract: 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).Abstract: 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.

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