Medium

Aug 31, 2023

The following is a summary of “Medium-Term Outcomes of the Different Antithrombotic Regimens After Transcatheter Aortic Valve Implantation,” published in the July 2023 issue of the Cardiovascular Disease by Naser et al.

Bioprosthetic valve thrombosis is characterized by the formation of blood clots on a bioprosthetic valve, which is linked to an expedited deterioration of the bioprosthesis and the need for valve re-replacement. The potential protective effects of 3-month warfarin use following transcatheter aortic valve implantation (TAVI) on associated consequences remain uncertain. Researcher’s objective was to examine whether a 3-month warfarin regimen following transcatheter aortic valve implantation (TAVI) is correlated with improved results compared to dual antiplatelet therapy (DAPT) and single antiplatelet therapy (SAPT) during the medium-term monitoring period. Adult individuals who underwent transcatheter aortic valve implantation (TAVI) were identified retrospectively (n=1,501). They were then categorized into three groups: warfarin, dual antiplatelet therapy (DAPT), and single antiplatelet therapy (SAPT), based on the specific antithrombotic regimen they received.

Patients presenting with atrial fibrillation were excluded from the study. The groups were compared in terms of outcomes and valve hemodynamics. The annualized alteration from the initial measurements in average gradients and effective orifice area during the most recent follow-up echocardiography was computed. In total, 844 patients were enrolled in the study, with a mean age of 80 ± 9 years. Among them, 43% were women. Out of the total, 633 patients received warfarin, 164 were on dual antiplatelet therapy (DAPT), and 47 were on single antiplatelet therapy (SAPT). The median duration of follow-up was 2.5 years, with an interquartile range of 1.2 to 3.9 years. There were no observed disparities in the adjusted outcome endpoints of ischemic stroke, mortality, valve re-replacement/intervention, structural valve degeneration, or their composite endpoint during the follow-up period.

The annual change in aortic valve area showed a significant increase in patients receiving dual antiplatelet therapy (DAPT) with a value of -0.11 [0.19] cm2/year, compared to those receiving warfarin with a value of -0.06 [0.25] cm2/year (P = 0.03). However, the two groups had no significant difference in the annual change in mean gradients (P >0.05). In summary, administering an antithrombotic treatment plan, which includes using warfarin following transcatheter aortic valve implantation (TAVI), was found to be linked to a slightly reduced reduction in the size of the aortic valve area. However, there were no discernible disparities in the clinical outcomes over the medium term compared to dual antiplatelet therapy (DAPT) and single antiplatelet therapy (SAPT).

Source: sciencedirect.com/science/article/abs/pii/S000291492300214X

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