Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI

Fabrizio D'Ascenzo*, Umberto Benedetto, Matteo Bianco, Federico Conrotto, Claudio Moretti, Augusto D'Onofrio, Marco Agrifoglio, Antonio Colombo, Flavio Ribichini, Giuseppe Tarantini, Maurizio D'Amico, Stefano Salizzoni, Mauro Rinaldi, on behalf of the ITER Investigators, Alaide Chieffo, Gennaro Giustino, Tommaso Regesta, Massimo Napodano, Davide Gabbieri, Francesco SaiaCorrado Tamburino, Diego Cugola, Marco Aiello, Francesco Sanna, Alessandro Iadanza, Esmeralda Pompei, Pierluigi Stefàno, Antioco Cappai, Alessandro Minati, Mauro Cassese, Gian Luca Martinelli, Andrea Agostinelli, Rosario Fiorilli, Francesco Casilli, Maurizio Reale, Francesco Bedogni, Anna Sonia Petronio, Pierluigi Omedè, Antonio Montefusco, Rosa Alba Mozzillo, Roberto Bonmassari, Carlo Briguori, Armando Liso, Gennaro Sardella, Giuseppe Bruschi, Gino Gerosa, Francesco Romeo

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

23 Citations (Scopus)

Abstract

Aims: The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. Methods and results: All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. Conclusions: After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.
Original languageEnglish
Pages (from-to)1392-1400
Number of pages9
JournalEurointervention
Volume13
Issue number12
Early online date8 Dec 2017
DOIs
Publication statusPublished - Dec 2017

Keywords

  • Aortic stenosis
  • Clinical research
  • Transcatheter aortic valve implantation (TAVI)

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    D'Ascenzo, F., Benedetto, U., Bianco, M., Conrotto, F., Moretti, C., D'Onofrio, A., Agrifoglio, M., Colombo, A., Ribichini, F., Tarantini, G., D'Amico, M., Salizzoni, S., Rinaldi, M., on behalf of the ITER Investigators, Chieffo, A., Giustino, G., Regesta, T., Napodano, M., Gabbieri, D., ... Romeo, F. (2017). Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI. Eurointervention, 13(12), 1392-1400. https://doi.org/10.4244/EIJ-D-17-00198